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Mini-Stroke Found to Precede 1 in 8 Strokes
Date:9/29/2009

ubsequent stroke that have been reported for decades, said Dr. Larry B. Goldstein, director of the Duke Stroke Center. But he disagrees with Hackam's interpretation of the predictive importance of TIAs.

"They predict 10 to 15 percent of strokes," Goldstein said. "This is not a small number, so it is an opportunity to prevent stroke that you don't want to miss when it happens."

Better predictive tools are available, Hackam said. He prefers carotid ultrasound, an inexpensive way to listen to blood flow in the main artery to the brain. "It's fairly inexpensive, and I do it for everyone I see in the clinic," Hackam noted.

His patients have been referred to the stroke clinic because they have the risk factors for stroke, which include old age, smoking, high blood pressure, obesity and high cholesterol, Hackam said. Results of a carotid ultrasound test can confirm the need for treatment not only with medications to control blood pressure and blood fats but also with lifestyle changes such as more exercise, no smoking and a less-fatty diet, Hackam said.

Goldstein, though, said that detailed tests such as carotid ultrasound are not needed to recommend such measures for people who have the risk factors for stroke. Those tests tend to measure not the specific risk of stroke but the risk of all cardiovascular problems, including heart attacks, he said.

"The more tests you do, the more chance there is to make a mistake," Goldstein said. "The standard risk factors can lead to recommending basic lifestyle changes. People who don't smoke, who drink moderately, who keep their blood pressure low, are less likely to have strokes."

And anyone who experiences a TIA should report it to a doctor immediately, Goldstein said. "It only matters if you are going to do something about it," he said. "A TIA identifies someone who is at high risk of having a stroke in a short period of time."

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