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Less than half of the patients said they realized they were having a transient ischemic attack when the symptoms started. But even those who suspected TIA weren't quicker to seek medical attention. Almost all of the patients (96%) recalled their first impressions of their symptoms. Of those patients, 42% said they thought they were having a transient ischemic attack. However, knowing TIA's symptoms didn't spur people to quickly seek medical help. As for the other patients who recalled their initial perception of their symptoms, nearly one in three said they didn't initially know what caused their symptoms. The rest said they suspected stress, eye problems, heart attack, or migraines were to blame.

Diet, exercise and drugs like allopurinol (all of which lower UA levels) could eventually be of value in reducing this risk, especially for those with additional risk factors such as diabetes, obesity and hypertension, the researchers say. But they caution that it would be premature to try this now. "Over a lifetime, it is common to have a small number of these mini strokes and not even notice," says Schretlen, "but as the overall volume of WMH increases, the damage can seriously disrupt how quickly we think and how effectively we learn and remember information."

Mini-strokes should never, as the Stroke Association points out, be ignored. In some cases, they are the prelude to another, usually more severe, attack. Studies show that after one, the chance of a further, more serious occurrence during the following week is as high as 30 per cent. For five years after a mini-stroke, 40 per cent of sufferers are at risk of a further attack, about half of which occur within the first year. Like major strokes, mini-strokes occur largely as a result of fatty material that builds up on artery walls, breaking off to lodge in small blood vessels leading to the brain. Blood clots may, similarly, be dislodged and block the flow of blood.

While there is consensus for rapid CT brain imaging, there is not agreement about the timing of other tests, such as carotid imaging. There is some interest in the use of an Accelerated Diagnostic Protocol (ADP), coupled with an Emergency Department Observational Unit, to avoid the average 3-day stay for admitted patients. This protocol may lower costs and reduce hospital stays, but questions remain about the outcomes and overall quality of care that such patients receive.

A transient ischaemic attack (TIA) is usually defined as causing symptoms for less than 24 hours, but it is unlikely that brain or eye is actually ischaemic for more than a few minutes. What we observe is the clinical effects of reversible impairment of neuronal function resulting from a short period of ischaemia. The risk of stroke after a TIA is about 12% in the first year and then about 7% a year thereafter, with risk of stroke, heart attack or vascular death being about 10% a year. This is about seven times the risk in the background population. But there is also a high risk of stroke in the seven days after a TIA, possibly as high as 10%.

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