Bret Michaels' small 'warning stroke' bears much more evaluation,  doctors say.
The mini stroke that sent rocker Bret Michaels back to the hospital resulted in tests that revealed he has a small hole in his heart, according to People magazine. And while doctors think the two conditions aren't related to Michaels' earlier brain hemorrhage, they say such a stroke, called a TIA (or transient ischemic attack) foreshadows a more severe stroke in the future.

"A TIA is a huge risk factor for subsequent stroke," says Dr. Louise McCullough, associate professor of neurology and neuroscience at the University of Connecticut Health Center. "The risk is quite high especially in the first week."

Calling a TIA an important warning sign that should be heeded, Dr. Emil L. Matarese, director of the Stroke Center at St. Mary's Medical Center in Langhorne, Pennsylvania, explains that it's caused by a temporary lack of circulation. It often occurs when an artery is narrowed and then plugged due to hardening of the arteries. Typically, a mini stroke lasts from 5 to 25 minutes, at which point the blood supply to the brain is reinstated.

"But it's a sign that should cause someone to act quickly," says Matarese, who's also a volunteer spokesperson for the American Heart Association/American Stroke Association. "I see patients who ignore the warning and go on to have a severe stroke."

About one third of patients who have a mini stroke will go on to suffer a more serious stroke, he says, though it's unpredictable to know whether it will occur within days or weeks.

Matarese says that the hole found in Michaels' heart may be what caused his mini stroke. If there's a small hole in the membrane that separates the right from the left side of the heart, the person runs the risk of having a small blood clot travel into the right side of the heart, shift to the left side and then go to the brain.

"This hole would not be picked up on a normal screening examination, and only after symptoms occur would tests be done," Matarese explains. "Doctors would look at the heart chambers to see if a hole is there."

It's a very treatable condition, he says. Doctors use a catheter to pass a small device through the hole, and "then they pull back and just like an umbrella opening up, this closes the hole," he says.

Sometimes anticoagulants (blood thinners) are used as an alternative treatment, but in the case of Michaels, these would not be prescribed because of his earlier brain hemorrhage, McCullough explains.

The rocker's heart condition is not uncommon, she says. "I would say 1 in 4 people has it," she explains "Everyone has this hole before birth, and after they are born and can breathe in oxygen on their own, the little hole closes up."

One risk factor for a blood clot is when someone has been lying in bed a lot, she says. Michaels had been confined to bed recently while in a coma following the brain hemorrhage and before that, recuperating from an appendectomy.

Now, doctors say, though Michaels is eager to get out of the hospital and on with his life, the best remedy is for him to get treatment, the same advice they give anyone who experiences stroke-like symptoms. These include dizziness, numbness (which is what Michaels experienced, according to People), weakness, trouble with balance and coordination or a sudden headache.

"If you have any of these warning signs, don't wait," Matarese says. "Get to the hospital right away and get evaluated."


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