Evolution of DWI signal abnormalities after transient ischemic attack and minor ischaemic stroke

Hdl Handle:
http://hdl.handle.net/10147/239015
Title:
Evolution of DWI signal abnormalities after transient ischemic attack and minor ischaemic stroke
Authors:
Merwick, A; Callally, E L; Duggan, J; Dolan, E; Hannon, N; Kavangh, E C; Lawler, L; Marnane, M; Moroney, J T; Moynagh, M R; Murphy, S; Ni Chroinin, D; O'Rourke, K; Sheehan, O C; Kelly, P J
Citation:
Cerebrovascular Diseases (2011) 31 SUPPL. 2 (67). : May 2011
Publisher:
Karger
Journal:
Cerebrovascular Diseases
Issue Date:
May-2011
URI:
http://hdl.handle.net/10147/239015
Additional Links:
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=Ausgabe&Ausgabe=255343&ProduktNr=224153
Abstract:
Background: Diffusion weighted imaging (DWI) signal abnormality after transient ischaemic attack (TIA) predicts early stroke, independently of other risk markers included in the ABCD3-I score. Early stroke recurrence detected on follow-up DWI after the acute-phase DWI may identify patients at high risk for subsequent clinicalstrokesstroke, cognitive impairment, and seizures. We aimed to determine the evolution of acute DWI lesions and rate of new ischaemic lesion (NIL) occurrence on follow-up DWI after TIA and minor stroke. Methods: Early DWI-detected stroke recurrence (defined as NILs on follow-up DWI one week after acute DWI) was identified in a prospective MRI study of TIA and minor stroke patients. Presence/absence of DWI lesion(s), topography, clinical variables, and clinical stroke recurrence by day 7 and 90 were recorded. Results: 87 patients were included, 65 TIA and 22 minor stroke. Study patients’ mean age was 68 years [Standard deviation 6], 64% male, mean ABCD2 score 4, mean ABCD3-I score 5 (TIA patients only). The median duration from symptom onset to acute (baseline) DWI was 2 days (Interquartile range 2-3) and to follow-up MRI was 10 days (IQR 8-12),with 7-day median interval between DWIs (IQR 5-9). 23/65 TIA patients (37.3% [95% CI 23.9-48.2]) had at least one DWI lesion at baseline. Early recurrent stroke occurred in 3.4% (3/87 patients) when defined clinically, compared to 6.9% [95% CI 2.6-14.4] (6/87) when defined by MRI (p<0.001). NILs were detected in 2/22 stroke patients 9.1% [95% CI 1.1-29.2] and 4/65 TIA patients 6.2% [95% CI 1.7-15.0]. In 60.9% [95% CI 38.5-80.3] TIA patients (14/23) with baseline DWI lesions, these were no longer detectable on early follow-up DWI. Discussion: Early follow-up DWI increased the identification of recurrent ischaemia compared to clinical evaluation alone. Early resolution of initial DWI lesions after TIA indicates the dynamic nature of ischaemic changes and importance of early MRI for risk stratification in practice.
Item Type:
Conference Presentation
Language:
en
Keywords:
STROKE

Full metadata record

DC FieldValue Language
dc.contributor.authorMerwick, Aen_GB
dc.contributor.authorCallally, E Len_GB
dc.contributor.authorDuggan, Jen_GB
dc.contributor.authorDolan, Een_GB
dc.contributor.authorHannon, Nen_GB
dc.contributor.authorKavangh, E Cen_GB
dc.contributor.authorLawler, Len_GB
dc.contributor.authorMarnane, Men_GB
dc.contributor.authorMoroney, J Ten_GB
dc.contributor.authorMoynagh, M Ren_GB
dc.contributor.authorMurphy, Sen_GB
dc.contributor.authorNi Chroinin, Den_GB
dc.contributor.authorO'Rourke, Ken_GB
dc.contributor.authorSheehan, O Cen_GB
dc.contributor.authorKelly, P Jen_GB
dc.date.accessioned2012-08-16T15:14:02Z-
dc.date.available2012-08-16T15:14:02Z-
dc.date.issued2011-05-
dc.identifier.citationCerebrovascular Diseases (2011) 31 SUPPL. 2 (67). : May 2011en_GB
dc.identifier.urihttp://hdl.handle.net/10147/239015-
dc.description.abstractBackground: Diffusion weighted imaging (DWI) signal abnormality after transient ischaemic attack (TIA) predicts early stroke, independently of other risk markers included in the ABCD3-I score. Early stroke recurrence detected on follow-up DWI after the acute-phase DWI may identify patients at high risk for subsequent clinicalstrokesstroke, cognitive impairment, and seizures. We aimed to determine the evolution of acute DWI lesions and rate of new ischaemic lesion (NIL) occurrence on follow-up DWI after TIA and minor stroke. Methods: Early DWI-detected stroke recurrence (defined as NILs on follow-up DWI one week after acute DWI) was identified in a prospective MRI study of TIA and minor stroke patients. Presence/absence of DWI lesion(s), topography, clinical variables, and clinical stroke recurrence by day 7 and 90 were recorded. Results: 87 patients were included, 65 TIA and 22 minor stroke. Study patients’ mean age was 68 years [Standard deviation 6], 64% male, mean ABCD2 score 4, mean ABCD3-I score 5 (TIA patients only). The median duration from symptom onset to acute (baseline) DWI was 2 days (Interquartile range 2-3) and to follow-up MRI was 10 days (IQR 8-12),with 7-day median interval between DWIs (IQR 5-9). 23/65 TIA patients (37.3% [95% CI 23.9-48.2]) had at least one DWI lesion at baseline. Early recurrent stroke occurred in 3.4% (3/87 patients) when defined clinically, compared to 6.9% [95% CI 2.6-14.4] (6/87) when defined by MRI (p<0.001). NILs were detected in 2/22 stroke patients 9.1% [95% CI 1.1-29.2] and 4/65 TIA patients 6.2% [95% CI 1.7-15.0]. In 60.9% [95% CI 38.5-80.3] TIA patients (14/23) with baseline DWI lesions, these were no longer detectable on early follow-up DWI. Discussion: Early follow-up DWI increased the identification of recurrent ischaemia compared to clinical evaluation alone. Early resolution of initial DWI lesions after TIA indicates the dynamic nature of ischaemic changes and importance of early MRI for risk stratification in practice.en_GB
dc.language.isoenen
dc.publisherKargeren_GB
dc.relation.urlhttp://content.karger.com/ProdukteDB/produkte.asp?Aktion=Ausgabe&Ausgabe=255343&ProduktNr=224153en_GB
dc.subjectSTROKEen_GB
dc.titleEvolution of DWI signal abnormalities after transient ischemic attack and minor ischaemic strokeen_GB
dc.typeConference Presentationen
dc.identifier.journalCerebrovascular Diseasesen_GB
dc.description.provinceLeinsteren
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