Images of brain after mild stroke predict future risk

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A CT scan of the brain within 24 hours of a mild, non-disabling stroke can predict when patients will be at the highest risk of another stroke or when symptoms may worsen, according to new research published in the American Heart Association journal Stroke.

“All patients should get a CT scan of their brain after a transient ischaemic attack (TIA) or non-disabling stroke,” says Jeffrey J Perry, co-senior author of the study and associate professor of emergency medicine at the University of Ottawa in Canada. “Images can help healthcare professionals identify patterns of damage associated with different levels of risk for a subsequent stroke or help predict when symptoms may get worse.”

Of 2,028 patients who received CT scans within 24 hours of a TIA or non-disabling stroke, 814 (40.1%) had brain damage due to ischaemia. Compared to patients without ischaemia, the probability of another stroke occurring within 90 days of the initial episode was:

  • 2.6 times greater if the CT image revealed newly damaged tissue due to acute ischaemia;
  • 5.35 times greater if tissue was previously damaged (chronic ischaemia) in addition to acute ischaemia;
  • 4.9 times greater if any type of small vessel damage occurred in the brain, such as narrowing of the microangiopathy, in addition to acute ischaemia;
  • 8.04 times greater if acute and chronic ischaemia occurred in addition to microangiopathy.

While 3.4% of the patients in the study group had a subsequent stroke within 90 days, 25% of patients with CT scans showing all three types of damage to their brain had strokes.

“During the 90-day period, and also within the first two days after the initial attack, patients did much worse in terms of experiencing a subsequent stroke if they had additional areas of damage along with acute ischemia,” says Perry, who is also a senior scientist at the Ottawa Hospital Research Institute.

“These findings should prompt physicians to be more aggressive in managing patients with TIA or non-disabling stroke who are diagnosed with acute ischaemia, especially if there is additional chronic ischaemia and/or microangiopathy.”

Measures to avert a new stroke might include cardiac monitoring or medications to lower blood pressure, treat high cholesterol or prevent blood clots. The researchers are assessing how to incorporate the study’s findings into stroke risk scores that rely on symptoms along with patient factors such as age and the presence of high blood pressure or diabetes.

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