Delays spell danger after minor stroke

Waiting time: Could it boost stroke risk?

Waiting even a couple of weeks for a consultant appointment after suffering a minor stroke increases the chance of having a major one, say researchers.

They are pushing for people who have a mini-stroke, or "transient ischaemic attack" (TIA), to be seen by an expert within a few days at most.

A minor stroke involves many of the tell-tale symptoms of a major stroke, such as limb weakness or numbness, or perhaps problems with speech or vision.

However, while in a full stroke these problems stay to leave the patient disabled, in a TIA or minor stroke they tend to clear up quickly, often within hours.

Many people here will ignore a minor stroke or TIA, or wait weeks before seeing a doctor

Dr Peter Rothwell, consultant neurologist

However, a study by doctors at Oxford's Radcliffe Infirmary confirms fears that a swift recovery does not mean that the danger is over.

Early estimates of the risk facing patients who have suffered minor strokes suggested that only one or two in a hundred suffered a subsequent full stroke within the next week - and only one in 20 within the month afterwards.

However, this research was based on strokes suffered after the patient had made it to see a consultant - usually at least a fortnight after the minor stroke.

More recent studies, including the Oxford research, suggest that this fortnight is an extremely dangerous one.

High stroke rate

Doctors now believe that one in 10 patients will suffer a full stroke within a week of a minor one, and up to one in five within a month.

And they suggest that many of these could be prevented if they are seen earlier by a neurologist.

Consultant neurologist Dr Peter Rothwell, who is presenting the research at the Stroke Association's annual conference on Tuesday, said that the UK should be trying to be more like the US.

In the US minor strokes are termed "brain attacks" - and taken far more seriously both by doctors and patients.

He told BBC News Online: "It is partly a matter of educating the public - many people here will ignore a minor stroke or TIA, or wait weeks before seeing a doctor.

"They need to go to their GP as soon as possible."

He helps run a daily minor stroke clinic at the Radcliffe Hospital - one of only a few in the country.

Improved service

On average, neurologists there see patients within a few days of the attack.

Before the launch of the clinic, the average was 19 days - more representative of the NHS in general.

Once patients arrive in a specialist clinic, there are a number of things that doctors can do to improve their chances.

Scans, if taken soon enough, might reveal whether the stroke is caused by a clot, in which case blood-thinning medication is in order, or a burst blood vessel - which would make that kind of treatment dangerous.

They can also identify a group of patients with a clot lodged in their carotid artery who are believed to be at even greater risk of a full stroke.

A simple operation to open up the blood vessel and extract the clot will solve the problem and cut the risk.

Dr Rothwell said: "Unfortunately it is very difficult to get seen quickly in the NHS - but we are hoping that this will change in future years."