Evolution of DWI signal abnormalities after transient ischemic attack and minor ischaemic stroke
dc.contributor.author | Merwick, A | |
dc.contributor.author | Callally, E L | |
dc.contributor.author | Duggan, J | |
dc.contributor.author | Dolan, E | |
dc.contributor.author | Hannon, N | |
dc.contributor.author | Kavangh, E C | |
dc.contributor.author | Lawler, L | |
dc.contributor.author | Marnane, M | |
dc.contributor.author | Moroney, J T | |
dc.contributor.author | Moynagh, M R | |
dc.contributor.author | Murphy, S | |
dc.contributor.author | Ni Chroinin, D | |
dc.contributor.author | O'Rourke, K | |
dc.contributor.author | Sheehan, O C | |
dc.contributor.author | Kelly, P J | |
dc.date.accessioned | 2012-08-16T15:14:02Z | |
dc.date.available | 2012-08-16T15:14:02Z | |
dc.date.issued | 2011-05 | |
dc.identifier.citation | Cerebrovascular Diseases (2011) 31 SUPPL. 2 (67). : May 2011 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10147/239015 | |
dc.description.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. | |
dc.language.iso | en | en |
dc.publisher | Karger | en_GB |
dc.relation.url | http://content.karger.com/ProdukteDB/produkte.asp?Aktion=Ausgabe&Ausgabe=255343&ProduktNr=224153 | en_GB |
dc.subject | STROKE | en_GB |
dc.title | Evolution of DWI signal abnormalities after transient ischemic attack and minor ischaemic stroke | en_GB |
dc.type | Conference Presentation | en |
dc.identifier.journal | Cerebrovascular Diseases | en_GB |
dc.description.province | Leinster | en |
html.description.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. |