Document Detail


Diffusion-weighted MRI in 300 patients presenting late with subacute transient ischemic attack or minor stroke.
MedLine Citation:
PMID:  15375305     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Many patients with transient ischemic attack (TIA) or minor stroke present to medical attention after a delay of several days or weeks, at which time it may be more difficult to obtain a clear history and clinical signs may have resolved. Because ischemic lesions on diffusion-weighted MRI (DWI) often persist for several weeks, we hypothesized that adding DWI to a standard protocol with T2-weighted imaging might be useful in the management of patients presenting late. METHODS: We studied consecutive patients with TIA or minor stroke presenting > or =3 days after the event. Two independent observers recorded the presence or absence of recent ischemic lesions on 2 different occasions, first with the T2 scan only, and second with T2 and DWI. Each time, with the aid of a written clinical summary, the observers recorded their diagnosis and proposed management. RESULTS: 300 patients (159 men) were scanned at a median of 17 (interquartile range=10 to 23) days after symptom onset. DWI showed a high signal lesion in 114/164 (70%) minor strokes versus 17/136 (13%) TIAs (P<0.0001). The presence of high-signal lesions on DWI decreased nonlinearly with time since symptom onset (P<0.0001) and increased with National Institutes of Health Stroke Score (P=0.038) and with age (P=0.01). In 90/206 (43.7%) patients with 1 or multiple lesions on T2, DWI helped to clarify whether these were related to a recent ischemic event (79 [48%] strokes; 11 [31%] TIAs). Compared with T2 alone, DWI provided additional information in 108 (36%) patients (91 [56%] strokes and 17 [13%] TIAs), such as clarification of clinical diagnosis (18 patients, 6%) or vascular territory (28 patients, 9.3%), which was considered likely to influence management in 42 (14%) patients (32 [19%] strokes; 10 [7.4%] TIAs). CONCLUSIONS: The clinically useful information available from DWI provides a further justification for an MRI-based imaging protocol in patients with subacute TIA or minor stroke.
Authors:
Ursula G Schulz; Dennis Briley; Tom Meagher; Andrew Molyneux; Peter M Rothwell
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Publication Detail:
Type:  Journal Article     Date:  2004-09-16
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  35     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-10-29     Completed Date:  2005-05-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2459-65     Citation Subset:  IM    
Affiliation:
Stroke Prevention Research Unit, Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Brain / pathology
Diffusion Magnetic Resonance Imaging*
Female
Humans
Ischemic Attack, Transient / diagnosis*
Male
Prospective Studies
Stroke / diagnosis*

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