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Set of stroke-like symptoms deemed predictive of risk.

LOS ANGELES -- Several stroke-like symptoms worked as strong risk factors for future strokes in patients with no history of strokes or transient ischemic attacks in a prospective study of more than 24,000 Americans.

"Having any stroke-like symptom was as predictive for future stroke as diabetes or atrial fibrillation. Having four or more stroke-like symptoms is higher risk than any other risk factor," Dr. Dawn O. Kleindorfer said at the conference.

Although these findings need confirmation and additional study, she envisioned eventually using the information to create a new risk-factor screen for the general adult population.

People without a known history of stroke who have stroke-like symptoms "are a group that hasn't been well described before. They are at increased risk for stroke, but [today] they don't get any kind of diagnosis. If we could design a way to ask questions that would predict the stroke risk in these patients, find them, and get them to medical care, we may help people at high stroke risk," said Dr. Kleindorfer, director of the division of vascular neurology at the University of Cincinnati.

Prior findings by Dr. Kleindorfer and her associates showed that 18% of Americans from the general public who had no known history of stroke or transient ischemic attack had at least one stroke-like symptom either currently or in the past.

The six questions ask about the sudden onset of painless hemibody weakness, painless hemibody numbness, difficulty understanding, difficulty speaking, loss of vision in one or both eyes, and loss of hemifield vision. These six questions derived from the Questionnaire for Verifying Stroke-Free Status (Stroke 2000;31: 1076-80), she said in an interview.

The new study involved 24,412 participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The new analysis excluded those who reported a history of stroke or transient ischemic attack. The researchers followed the study group for a median of 4.4 years, during which time this group had 381 incident strokes.

In an analysis that adjusted for the standard elements of the Framingham Stroke Risk Score, the researchers identified three stroke-like symptoms significantly linked with an increased risk for incident stroke: difficulty speaking, difficulty understanding, and numbness. (See chart.) These three symptoms each contributed approximately 2%, 2%, and 1%, respectively, of total stroke risk, making them at least as important to risk as diabetes and atrial fibrillation.

Each of the other three stroke-like symptoms - weakness, half vision, and total vision impairment - did not individually have a statistically significant link to stroke incidence. However, collectively having a single stroke-like symptom of any type increased a person's relative risk for stroke by 36%, and represented more than 1% of total stroke risk. Among people with more than one stroke-like symptom, each additional symptom increased stroke risk by a relative, statistically significant 21%, and overall multiple symptoms constituted nearly 3% of all stroke risk. These numbers meant that if a person had four stroke-like symptoms, their relative risk of an incident stroke during 4.4 years of follow-up more than doubled, Dr. Kleindorfer said.
Associated Risk of Stroke-Like Symptoms

Clinical parameter Hazard ratio Percentage of
 for stroke prediction
 during follow-up information for stroke

Any stroke 1.36 * 1.4%

Multiple stroke 1.21 * 2.7%
(per number of symptoms)

Difficulty communicating 1.75 * 1.8%

Difficulty understanding 1.87 * 1.8%

Numbness 1.36 * 0.5%

Weakness 1.32 0.9%

Full vision impaired 1.37 0.5%

Half vision impaired 1.53 0.9%

Age (per decade) 2.11 * 26.8% (with race)

Race (at age 65) 1.41 * 26.8% (with age)

Systolic blood pressure 1.14 * 4.1%
(per 10 mm Hg)

Current smoker 2.05 * 3.6%

Diabetes 1.40 * 1.4%

Atrial fibrillation 1.43 * 0.9%

History of 1.46 * 2.7%
heart disease

* Statistically significant hazard ratio between people with parameter
and those without Note: Based on an analysis of 24,412 REGARDS
enrollees. Source: Dr. Kleindorfer

Dr. Kleindorfer said that she has been a consultant to Genentech and Boehringer Ingelheim.


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Title Annotation:NEUROLOGY
Author:Zoler, Mitchel L.
Publication:Internal Medicine News
Article Type:Clinical report
Date:Mar 15, 2011
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