Strokes could be predicted and prevented by new test, says The Stroke Association

21/06/2005

Strokes could be predicted and prevention improved by use of a risk score developed by scientists at Oxford University, according to new research published by The Lancet this week. The findings, part-funded by The Stroke Association, could mean a change to the way that people who have had Transient Ischaemic Attacks (TIAs) or ‘mini strokes’ are assessed and treated.

TIAs are similar to strokes but usually last only a few minutes. However, as many as one in five people who have a TIA will go on to have a major stroke within a month. The greatest risk is within the first 72 hours. The Oxford-based Stroke Prevention Research Unit looked into ways of identifying which people who have had a TIA are at highest risk of having a stroke. They identified four factors that could predict this risk:

· Age of patients
· Blood pressure
· The Clinical features patients presented with
· Duration of TIA symptoms

These predictive factors were combined to create the ‘ABCD score’ as a way of quantifying this risk. The risk of stroke within seven days of TIA was over 30% in patients with a high ABCD score, whereas there were no early strokes in patients with low scores. Professor Rothwell states: “Although further validations and refinements will be helpful, the ABCD score can be used in routine clinical practice to identify high-risk individuals who need emergency investigation and treatment.”

Current clinical guidelines recommend that TIA patients be assessed and treated at specialist clinics within seven days of their symptoms, but in most parts of the UK patients face delays of two weeks or more for appointments. The researchers found that most strokes that occurred in the first few days and weeks after a TIA occurred in patients who had been referred to a hospital clinic for investigation but had yet to be seen. “Current guidelines on the urgency with which TIA patients are investigated need to be revised,” commented Professor Rothwell.

“These improvements would not require an increase in funding and could be achieved simply by more effective use of existing resources; however, changes in health service policy would be needed for this to be achieved.”

Although TIA and stroke are as common as acute coronary events, public knowledge of the warning symptoms is poor. “Public education about the need to seek medical attention urgently after a TIA has been difficult thus far because of the wide variety of possible symptoms of TIA,” Rothwell states. “However, our results show that the vast majority of early strokes occur after TIAs with a few specific symptoms. These results should allow public education to be effectively focused.”

“All too often TIAs are ignored. But Professor Rothwell’s work can help to predict whether someone who has had a TIA is going to have a catastrophic stroke that could be fatal or severely disabling. It is essential that all TIAs are diagnosed quickly so that patients can be assessed and immediately started on the most appropriate course of treatment. ” commented Joe Korner, Director of Communications at The Stroke Association.

“Stroke is the UK’s third biggest killer and the single largest cause of severe disability. Major strokes are often preceded by a TIA. This simple score has been proven to predict whether a person who has had a TIA is at high risk of stroke. The Stroke Association urges the Department of Health to make sure that all GPs and hospital professionals are aware of this vital tool so that they are able to refer people quickly and in time for urgent intervention.”

ENDS

For further information please contact the Media Team at The Stroke Association on 020 7566 0328 or e-mail press@stroke.org.uk.

Professor Peter M Rothwell, Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK; T) +44 (0)1865 224237 or +44 (0)1865 224639; F) +44 (0)1865 228572; E) peter.rothwell@clneuro.ox.ac.uk (copied to tracey.brock@clneuro.ox.ac.uk to ensure a rapid response).

Notes to editor

1. Each year over 130,000 people in England and Wales have a stroke. Of all people who suffer from a stroke, about a third are likely to die within the first 10 days, about a third are likely to make a recovery within one month and about a third are likely to be left disabled and needing rehabilitation. Stroke has a greater disability impact than any other medical condition. A quarter of a million people are living with long-term disability as a result of stroke in the UK.

2. The Stroke Association is the only national charity solely concerned with combating stroke in people of all ages. It funds research into prevention, treatment and better methods of rehabilitation and helps stroke patients and their families directly through its community services. These include dysphasia support, family support, information services, welfare grants, publications and leaflets. We also campaign, educate and inform to increase knowledge of stroke at all levels of society and we act as a voice for everyone affected by stroke.

3. A stroke happens when the blood supply to the brain is disrupted. Most strokes occur when a blood clot blocks the flow of blood to the brain. Some strokes are caused by bleeding in or around the brain from a burst blood vessel. When the blood supply is disrupted, parts of the brain become damaged or destroyed. Some strokes are fatal whist others can cause permanent or temporary paralysis to one side of the body and loss of the ability to speak, read or write. Recovery may be slow and can vary from person to person.

The Stroke Association