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Tanaka K, Coutts SB, Joundi RA, Singh N, Uehara T, Ohara T, Koga M, Koge J, Toyoda K, Penn AM, Balshaw RF, Bibok MMB, Votova K, Smith EE, Minematsu K, Demchuk AM. Presenting Symptoms and Diffusion-Weighted MRI Positivity by Time After Transient Neurologic Events: A Pooled Analysis of 3 Cohort Studies. Neurology 2024; 102:e207846. [PMID: 38165379 PMCID: PMC10834141 DOI: 10.1212/wnl.0000000000207846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The association between focal vs nonfocal presenting symptom and diffusion-weighted imaging (DWI) positivity in relation to onset-to-imaging time in patients with transient neurologic events remains unclear. We hypothesize that episodes consisting of focal symptoms would have proportionally higher DWI-positive imaging at later onset-to-imaging times. METHODS Patients with transient neurologic symptoms and a normal neurologic examination who had DWI in the combined data set of 3 cohort studies were included. We used logistic regression models to evaluate the association between each type of presenting symptom (motor weakness, speech impairment, sensory symptoms, vision loss, diplopia, gait instability, dizziness, headache, presyncope, and amnesia) and DWI positivity after adjusting for clinical variables (age, sex, history of stroke, dyslipidemia, coronary artery disease, atrial fibrillation, symptoms duration [<10, 10-59, ≥60 minutes, or unclear], and study source). We stratified the results by onset-to-imaging time categories (<6 hours, 6-23 hours, and ≥24 hours). RESULTS Of the total 2,411 patients (1,345 male, median age 68 years), DWI-positive lesions were detected in 598 patients (24.8%). The prevalence of DWI positivity was highest in those with motor weakness (34.7%), followed by speech impairment (33.5%). In a multivariable analysis, the presence of motor weakness, speech impairment, and sensory symptoms was associated with DWI positivity, while vision loss and headache were associated with lower odds of DWI positivity, but nevertheless had 13.6% and 15.3% frequency of DWI positive. The odds of being DWI positive varied by onset-to-imaging time categories for motor weakness, with greater odds of being DWI positive at later imaging time (<6 hours: odds ratio [OR] 1.25, 95% confidence interval [CI] 0.84-1.87; 6-23 hours: OR 2.24, 95% CI 1.47-3.42; and ≥24 hours: OR 2.42, 95% CI 1.74-3.36; interaction p = 0.033). Associations of other symptoms with DWI positivity did not vary significantly by time categories. DISCUSSION We found that onset-to-imaging time influences the relationship between motor weakness and DWI positivity in patients with transient neurologic events. Compared with motor, speech, and sensory symptoms, visual or nonfocal symptoms carry a lower but still a substantive association with DWI positivity.
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Affiliation(s)
- Koji Tanaka
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Shelagh B Coutts
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Raed A Joundi
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Nishita Singh
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Tohiyuki Uehara
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Tomoyuki Ohara
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Masatoshi Koga
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Junpei Koge
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Kazunori Toyoda
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Andrew M Penn
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Robert F Balshaw
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Maximilian M B Bibok
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Kristine Votova
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Eric E Smith
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Kazuo Minematsu
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Andrew M Demchuk
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
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