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Study Shows:
Patients with Mild Stroke Need Treatment Too
Patients showing symptoms of a mild stroke should not be excluded from receiving clot-dissolving therapy because of the belief that they will do well without treatment, according to results of a study by the Stroke Team at The University of Texas Medical School at Houston.
Nicole Gonzales, M.D., a stroke fellow in the Department of Neurology, won the Mordecai Y. T. Globus New Investigator Award in Stroke for the research at the International Stroke Conference 2006, sponsored by the American Stroke Association. The award carried a $500 prize and an all-expenses paid trip to the conference in Kissimmee, Fla.
“Even though I received the award, it really is a reflection of a team effort,” she said.
Gonzales’ two-year fellowship is through the Medical School’s Stroke Treatment Team, which is Houston’s premier medical team for the treatment of acute stroke. It was formed in 1988 by James Grotta, M.D., holder of the Roy M. and Phyllis Gough Huffington Distinguished Chair in Neurology.
For the study Gonzales and her fellow Stroke Team members screened 885 patients with a diagnosis of mild stroke. The effects from a mild stroke may be a facial droop, difficulty speaking or slightly impaired strength. With a major stroke, the effects may be paralysis on one side of the body or inability to communicate.
Many patients with mild symptoms of stroke are not treated with the clot-dissolving medication tPA (tissue plasminogen activator), even if they seek medical attention within the three-hour window in which such treatment is effective.
Because the main side effect from tPA is hemorrhage, Gonzales said, “the thought is why subject these patients to the risk of hemorrhage with the use of tPA if they have a good prognosis anyway.”
Gonzales divided the patients into two groups for the study: one received treatment with tPA, the other did not.
“Patients treated with tPA were more likely to have an excellent outcome,” she said. “As a whole, 59 percent of the tPA group had an excellent outcome, compared to 44 percent of the untreated group.”
In addition, “our research showed the risk of hemorrhage in mild stroke patients may not be as high as in the entire group of tPA-treated patients,” she said.
Co-authors for the study included the following Stroke Team members: Karen Albright, D.O., neurology resident; Elizabeth Noser, M.D., assistant professor of neurology; Aslam Khaja, M.D., neurology clinical fellow; Hashem Shaltoni, M.D., neuroradiology clinical fellow; Adam Romman; Neal Zimbaldi, Coordinating Center for Clinical Trials, UT School of Public Health; Mary Baraniuk, Ph.D., assistant professor in biostatistics, Public Health; Lemuel Moyé, M.D., Ph.D., professor in biostatistics, Public Health; and Grotta.
By Camille Webb, Medical School