Recent findings published in the June issue of Stroke suggest that there are several factors associated with stroke recurrence in patients who have had a TIA or minor stroke.

Recent findings published in the June issue of Stroke suggest that there are several factors associated with stroke recurrence in patients who have had a transient ischemic attack (TIA) or minor stroke.

"Stroke recurrence in patients with an initial nondisabling acute ischemic stroke is one of the most frustrating medical situations," Dr. Angel Ois, of Hospital del Mar, Barcelona, and colleagues write. Studies to detect patients at high neurological risk have had increased relevance, but "stronger predictors of stroke recurrence are needed to enable practitioners to (make) clinical decisions."

Dr. Ois and colleagues examined factors associated with stroke recurrence in 689 patients with a National Institutes of Health Stroke Scale (NIHSS) score below four at hospital admission. All of the patients had experienced a TIA or minor stroke. The study end point was a new neurological event at seven or 90 days. The patients had a mean age of 71.73 years and mean length of hospital stay of 4.54 days.

After seven days, 62 (nine per cent) of the patients had stroke recurrence and after 90 days, 111 (16.1 per cent) had stroke recurrence.

Severe symptomatic extra- or intracranial arterial disease, with arterial stenosis of 70 per cent or greater, was independently associated with stroke recurrence at 90 days (odds ratio = 4.97).

Other independent factors associated with 90-day stroke recurrence included weakness (OR = 3.25), speech impairment (OR = 1.96), vertebrobasilar events (OR = 2.87), previous TIA (OR = 4.62), severe alcohol intake (OR = 4.18) and heart failure (OR = 2.41).

Stroke recurrence at seven days was also independently associated with severe symptomatic extra- or intracranial arterial disease (OR = 7.73), along with TIA (OR = 3.45) and minor stroke (OR = 5.15).

The researchers separately examined the variables associated with recurrence at 90 days in multivariate models. In patients with TIA, an independent association was observed between 90-day recurrence and weakness, duration of symptoms, previous TIA, and severe symptomatic extra- or intracranial arterial disease.

In patients with minor stroke, an independent association was found between a new event and weakness, speech impairment, severe alcohol intake, previous TIA, and severe symptomatic extra- or intracranial arterial disease.

"In those patients with initial non-disabling symptoms (these findings are) of special importance," Dr. Ois said in an interview with Reuters Health.

Stroke 2008;39:1717-1721