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Moores M, Joundi RA, Singh N, Penn AM, Votova K, Smith EE, Coutts SB. Magnetic Resonance Imaging Assists With Determining Etiology After Transient Ischemic Attack or Minor Stroke. J Am Heart Assoc 2024; 13:e033817. [PMID: 38533977 DOI: 10.1161/jaha.123.033817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Magnetic resonance imaging infarct topography may assist with determining stroke etiology. The influence of diffusion-weighted imaging (DWI)-positive lesions on etiology determination in patients with transient ischemic attack or minor stroke is not well studied. METHODS AND RESULTS We prospectively enrolled patients between 2010 and 2017 in 2 studies; participants with a final diagnosis of probable or definite transient ischemic attack or stroke were pooled for analysis. The primary outcome was the adjudicated ischemic etiology. We compared proportion of each etiology (cardioembolic, large-vessel, small-vessel disease, other) in patients who had DWI positivity compared with DWI negativity. We used logistic regression to determine the adjusted odds ratio (OR) for each etiology compared with undetermined by DWI positivity. The final analysis included 1498 patients: 832 (55.5%) were DWI-positive. DWI-positive patients were more likely to be diagnosed with small-vessel disease (19.1% versus 5.3%) and less likely with undetermined etiology (36.9% versus 53.0%; P<0.001). After adjustment, the presence of any DWI lesion was associated with increased odds of assigning any etiology (OR, 1.8 [95% CI, 1.3-2.5]). A single DWI lesion was associated with increased odds of small-vessel disease diagnosis (OR, 9.5 [95% CI, 6.4-14.0]), and multiple DWI lesions with reduced odds of small-vessel disease (OR, 0.2 [95% CI, 0.1-0.4]) but increased odds of all other etiologies compared with undetermined etiology. CONCLUSIONS Any DWI-positive lesion after suspected transient ischemic attack or minor stroke was associated with increased odds of assigning a etiology. Presence and topography of DWI lesions on magnetic resonance imaging may assist with etiology determination and may impact stroke prevention therapies.
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Affiliation(s)
- Margaret Moores
- Kelowna General Hospital & University of British Columbia Kelowna British Columbia Canada
| | - Raed A Joundi
- Faculty of Health Sciences McMaster University Hamilton Ontario Canada
| | - Nishita Singh
- Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Andrew M Penn
- Stroke Rapid Assessment Unit, Island Health Victoria British Columbia Canada
| | - Kristine Votova
- Island Health Regional Health Authority, Division of Medical Sciences University of Victoria Victoria British Columbia Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine University of Calgary Calgary Alberta Canada
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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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Purroy F, Ois A, Jove M, Arque G, Sol J, Mauri-Capdevila G, Rodriguez-Campello A, Pamplona R, Portero M, Roquer J. Lipidomic signature of stroke recurrence after transient ischemic attack. Sci Rep 2023; 13:13706. [PMID: 37607967 PMCID: PMC10444771 DOI: 10.1038/s41598-023-40838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 08/17/2023] [Indexed: 08/24/2023] Open
Abstract
While TIA patients have transient symptoms, they should not be underestimated, as they could have an underlying pathology that may lead to a subsequent stroke: stroke recurrence (SR). Previously, it has been described the involvement of lipids in different vascular diseases. The aim of the current study was to perform a lipidomic analysis to identify differences in the lipidomic profile between patients with SR and patients without. Untargeted lipidomic analysis was performed in plasma samples of 460 consecutive TIA patients recruited < 24 h after the onset of symptoms. 37 (8%) patients suffered SR at 90 days. Lipidomic profiling disclosed 7 lipid species differentially expressed between groups: 5 triacylglycerides (TG), 1 diacylglyceride (DG), and 1 alkenyl-PE (plasmalogen) [specifically, TG(56:1), TG(63:0), TG(58:2), TG(50:5), TG(53:7, DG(38:5)) and PE(P-18:0/18:2)]. 6 of these 7 lipid species belonged to the glycerolipid family and a plasmalogen, pointing to bioenergetics pathways, as well as oxidative stress response. In this context, it was proposed the PE(P-18:0/18:2) as potential biomarker of SR condition.The observed changes in lipid patterns suggest pathophysiological mechanisms associated with lipid droplets metabolism and antioxidant protection that is translated to plasma level as consequence of a more intensive or high-risk ischemic condition related to SR.
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Affiliation(s)
- F Purroy
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain.
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain.
| | - A Ois
- Department of Neurology, Neurology Neurovascular Research Unit Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - M Jove
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), 25198, Lleida, Spain
| | - G Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain
| | - J Sol
- Institut Català de la Salut (ICS), Atenció Primària, Lleida, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain
| | - G Mauri-Capdevila
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain
| | - A Rodriguez-Campello
- Department of Neurology, Neurology Neurovascular Research Unit Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - R Pamplona
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), 25198, Lleida, Spain
| | - M Portero
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), 25198, Lleida, Spain
| | - J Roquer
- Department of Neurology, Neurology Neurovascular Research Unit Hospital del Mar Research Institute (IMIM), Barcelona, Spain
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Purroy F, Vicente-Pascual M, Arque G, Begue R, Farre J, Gallego Y, Gil-Villar MP, Mauri G, Montalà N, Pereira C, Torres-Querol C, Vazquez-Justes D. Risk of New-Diagnosed Atrial Fibrillation After Transient Ischemic Attack. Front Neurol 2022; 13:905304. [PMID: 35911925 PMCID: PMC9331650 DOI: 10.3389/fneur.2022.905304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background Transient ischemic attack (TIA) provides a unique opportunity to optimize secondary preventive treatments to avoid subsequent ischemic stroke (SIS). Although atrial fibrillation (AF) is the leading cause of cardioembolism in IS and anticoagulation prevents stroke recurrence (SR), limited data exists about the risk of new-diagnosed AF (NDAF) after TIA and the consequences of the diagnostic delay. The aim of our study was to determine this risk in a cohort of TIA patients with long-term follow-up. Methods We carried out a prospective cohort study of 723 consecutive TIA patients from January 2006 to June 2010. Median follow-up was 6.5 (5.0–9.6) years. In a subgroup of 204 (28.2%) consecutive patients, a panel of biomarkers was assessed during the first 24 h of the onset of symptoms. Multivariate analyses were performed to find out the associated factors of NDAF. Kaplan-Meier analysis was also performed to analyzed risk of SIS. Results NDAF was indentified in 116 (16.0%) patients: 42 (36.2%) during admission, 18 (15.5%) within first year, 29 (25%) between one and five years and 27 (23.3%) beyond 5 years. NDAF was associated with sex (female) [hazard ratio (HR) 1.61 (95% CI, 1.07- 2.41)], age [[HR 1.05 (95% CI, 1.03–1.07)], previous ischemic heart disease (IHD) [HR 1.84, (95% CI 1.15–2.97)] and cortical DWI pattern [HR 2.81 (95% CI, 1.87–4.21)]. In the Kaplan-Meier analysis, NT-proBNP ≥ 218.2 pg/ml (log-rank test P < 0.001) was associated with significant risk of NDAF during the first 5 years of follow-up. Patients with NDAF after admission and before 5 years of follow-up had the highest risk of SIS (P = 0.002). Conclusion The risk of NDAF after TIA is clinically relevant. We identified clinical and neuroimaging factors of NDAF. In addition, NT-proBNP was related to NDAF. Our results can be used to evaluate the benefit of long-term cardiac monitoring in selected patients.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Mikel Vicente-Pascual
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gloria Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Robert Begue
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Joan Farre
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Yhovany Gallego
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Maria Pilar Gil-Villar
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Nuria Montalà
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
- Hospital Universitari Santa Maria de Lleida, Lleida, Spain
| | - Cristina Pereira
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Coral Torres-Querol
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Daniel Vazquez-Justes
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
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Zhao L, Cao S, Pei L, Fang H, Liu H, Wu J, Sun S, Gao Y, Song B, Xu Y. Validation of CSR model to predict stroke risk after transient ischemic attack. Sci Rep 2022; 12:604. [PMID: 35022460 PMCID: PMC8755815 DOI: 10.1038/s41598-021-04405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
It is essential to identify high risk transient ischemic attack (TIA) patients. The previous study reported that the CSR (comprehensive stroke recurrence) model, a neuroimaging model, had a high predictive ability of recurrent stroke. The aims of this study were to validate the predictive value of CSR model in TIA patients and compare the predictive ability with ABCD3-I score. Data were analyzed from the prospective hospital-based database of patients with TIA which defined by the World Health Organization time-based criteria. The predictive outcome was stroke occurrence at 90 days. The receiver-operating characteristic (ROC) curves were plotted and the C statistics were calculated as a measure of predictive ability. Among 1186 eligible patients, the mean age was 57.28 ± 12.17 years, and 474 (40.0%) patients had positive diffusion-weighted imaging (DWI). There were 118 (9.9%) patients who had stroke within 90 days. In 1186 TIA patients, The C statistic of CSR model (0.754; 95% confidence interval [CI] 0.729–0.778) was similar with that of ABCD3-I score (0.717; 95% CI 0.691–0.743; Z = 1.400; P = 0.1616). In 474 TIA patients with positive DWI, C statistic of CSR model (0.725; 95% CI 0.683–0.765) was statistically higher than that of ABCD3-I score (0.626; 95% CI 0.581–0.670; Z = 2.294; P = 0.0245). The CSR model had good predictive value for assessing stroke risk after TIA, and it had a higher predictive value than ABCD3-I score for assessing stroke risk for TIA patients with positive DWI.
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Affiliation(s)
- Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shuang Cao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Lulu Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hui Fang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hao Liu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shilei Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Shahjouei S, Sadighi A, Chaudhary D, Li J, Abedi V, Holland N, Phipps M, Zand R. A 5-Decade Analysis of Incidence Trends of Ischemic Stroke After Transient Ischemic Attack: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78:77-87. [PMID: 33044505 DOI: 10.1001/jamaneurol.2020.3627] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Management of transient ischemic attack (TIA) has gained significant attention during the past 25 years after several landmark studies indicated the high incidence of a subsequent stroke. Objective To calculate the pooled event rate of subsequent ischemic stroke within 2, 7, 30, and 90 days of a TIA and compare this incidence among the population with TIA recruited before 1999 (group A), from 1999 to 2007 (group B), and after 2007 (group C). Data Sources All published studies of TIA outcomes were obtained by searching PubMed from 1996, to the last update on January 31, 2020, irrespective of the study design, document type, or language. Study Selection Of 11 516 identified citations, 175 articles were relevant to this review. Both the classic time-based definition of TIA and the new tissue-based definition were accepted. Studies with a combined record of patients with TIA and ischemic stroke, without clinical evaluation for the index TIA, with diagnosis of index TIA event after ischemic stroke occurrence, with low suspicion for TIA, or duplicate reports of the same database were excluded. Data Extraction and Synthesis The study was conducted and reported according to the PRISMA, MOOSE, and EQUATOR guidelines. Critical appraisal and methodological quality assessment used the Quality in Prognosis Studies tool. Publication bias was visualized by funnel plots and measured by the Begg-Mazumdar rank correlation Kendall τ2 statistic and Egger bias test. Data were pooled using double arcsine transformations, DerSimonian-Laird estimator, and random-effects models. Main Outcomes and Measures The proportion of the early ischemic stroke after TIA within 4 evaluation intervals (2, 7, 30, and 90 days) was considered as effect size. Results Systematic review yielded 68 unique studies with 223 866 unique patients from 1971 to 2019. The meta-analysis included 206 455 patients (58% women) during a span of 4 decades. The overall subsequent ischemic stroke incidence rates were estimated as 2.4% (95% CI, 1.8%-3.2%) within 2 days, 3.8% (95% CI, 2.5%-5.4%) within 7 days, 4.1% (95% CI, 2.4%-6.3%) within 30 days, and 4.7% (95% CI, 3.3%-6.4%) within 90 days. There was a recurrence risk of 3.4% among group A in comparison with 2.1% in group B or 2.1% in group C within 2 days; 5.5% in group A vs 2.9% in group B or 3.2% in group C within 7 days; 6.3% in group A vs 2.9% in group B or 3.4% in group C within 30 days, and 7.4% in group A vs 3.9% in group B or 3.9% in group C within 90 days. Conclusions and Relevance These findings suggest that TIA continues to be associated with a high risk of early stroke; however, the rate of post-TIA stroke might have decreased slightly during the past 2 decades.
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Affiliation(s)
- Shima Shahjouei
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Alireza Sadighi
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Durgesh Chaudhary
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania.,Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia
| | - Neil Holland
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Michael Phipps
- Department of Neurology, University of Maryland, Baltimore
| | - Ramin Zand
- Department of Neurology, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
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Purroy F, Vicente-Pascual M, Arque G, Baraldes-Rovira M, Begue R, Gallego Y, Gil MI, Gil-Villar MP, Mauri G, Quilez A, Sanahuja J, Vazquez-Justes D. Sex-Related Differences in Clinical Features, Neuroimaging, and Long-Term Prognosis After Transient Ischemic Attack. Stroke 2021; 52:424-433. [PMID: 33493055 PMCID: PMC7834662 DOI: 10.1161/strokeaha.120.032814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Differences in sex in the incidence, presentation, and outcome of events after ischemic stroke have been studied in depth. In contrast, only limited data are available after transient ischemic attack (TIA). We aim to assess sex-related differences in the presentation, cause, neuroimaging features, and predictors of long-term prognosis in patients with TIA.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Mikel Vicente-Pascual
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Gloria Arque
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Mariona Baraldes-Rovira
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Robert Begue
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Yhovany Gallego
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - M Isabel Gil
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - M Pilar Gil-Villar
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Alejandro Quilez
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Jordi Sanahuja
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Daniel Vazquez-Justes
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
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8
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Lodha N, Patel P, Harrell J, Casamento-Moran A, Zablocki V, Christou EA, Poisson SN. Motor impairments in transient ischemic attack increase the odds of a positive diffusion-weighted imaging: A meta-analysis. Restor Neurol Neurosci 2020; 37:509-521. [PMID: 31594263 DOI: 10.3233/rnn-190940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Unilateral motor impairment is a key symptom used in the diagnosis of transient ischemic attack (TIA). Diffusion-weighted imaging (DWI) is a promising diagnostic tool for detecting ischemic lesions. While both motor impairments and DWI abnormalities are linked to the diagnosis of TIA, the association between these prognostic factors is not well understood. OBJECTIVE To examine the association between unilateral motor impairments and the odds of a positive DWI in TIA. Further, to determine whether the time between symptom onset and neuroimaging (delay to scan) influences the odds of a positive DWI. METHODS We used PRISMA guidelines to conduct a systematic search from 1989 to 2018. We included studies that reported number of individuals with/without unilateral motor symptoms and a positive/negative DWI. RESULTS Twenty-four studies from North America, Australia, Asia, and Europe were submitted to a meta-analysis. A pooled odds ratio of 1.80 (95% CI, 1.45-2.24, p = 0.00; I2 = 57.38) suggested that the odds of a positive DWI are greater in TIA individuals who experience motor symptoms as compared with those who experience no motor symptoms. Further, increasing the time delay to scan from the symptom onset (>2 days) did not influence the odds of a positive DWI as compared with an earlier scan (≤2 days). CONCLUSIONS The current meta-analysis provides cumulative evidence from 6710 individuals with TIA that the presence of motor symptoms increases the odds of a positive DWI by two-folds. These findings transform the clinical perception into evidence-based knowledge that motor impairments elevate the risk for brain tissue damage. Unilateral motor impairments in a cerebrovascular event should increase a physician's suspicion of detecting brain infarctions. These findings may influence the clinical management of TIA by generating faster response to motor impairments in TIA and accelerating referral to specialized stroke clinic.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Jane Harrell
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | | | - Victoria Zablocki
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Sharon N Poisson
- Department of Neurology, University of Colorado, Aurora, CO, USA
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9
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Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors. Sci Rep 2019; 9:16248. [PMID: 31700058 PMCID: PMC6838079 DOI: 10.1038/s41598-019-52721-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/22/2019] [Indexed: 01/14/2023] Open
Abstract
Few previous studies have focused on affective impairment after transient ischemic attack (TIA) and/or minor stroke. The aim was to establish the prevalence, evolution and predictors of post-stroke depression (PSD) and post-stroke apathy (PSA) over a 12-month follow-up period. We prospectively included TIA and minor stroke patients (NIHSS ≤4) who had undergone magnetic resonance imaging <7 days. PSD was diagnosed according to DSM-5 criteria and PSA was defined based on an Apathy Evaluation Scale (AES-C) score of ≥37. Clinical and neuroimaging variables (presence and patterns of lesion, cerebral bleeds and white matter disease) were analysed in order to find potential predictors for PSD and PSA. Follow-up was performed at 10 days and after 2, 6, 9 and 12 months. 82 patients were included (mean 66.4 [standard deviation11.0] years) of whom 70 completed the follow-up. At 10 days, 36 (43.9%) and 28 (34.1%) patients respectively were diagnosed with PSD and PSA. At 12 months, 25 of 70 (35.7%) patients still had PSA, but only 6 of 70 (8.6%) had PSD. Beck Depression Inventory-II score, mini mental state examination (MMSE) and a previous history of depression or anxiety were predictors for PSD. While MMSE score, The Montgomery Asberg Depression Rating Scale and having previously suffered a stroke were also risk factors for PSA. Acute basal ganglia lesion and periventricular leukoaraiosis were associated with PSA while deep leukorariosis with PSD. Despite the presence of few or only transient symptoms, PSD and PSA frequent appear early after TIA and minor stroke. Unlike PSD, apathy tends to persist during follow-up.
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Yuan J, Jia Z, Song Y, Yang S, Li Y, Yang L, Qin W, Hu W. Incidence and Predictors of Acute Ischemic Lesions on Brain Magnetic Resonance Imaging in Patients With a Clinical Diagnosis of Transient Ischemic Attack in China. Front Neurol 2019; 10:764. [PMID: 31379718 PMCID: PMC6646584 DOI: 10.3389/fneur.2019.00764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background: The associations between the clinical characteristics and diffusion-weighted imaging (DWI) positivity in patients with a clinical diagnosis of transient ischemic attack (TIA) are still poorly understood. The purpose of our study was to determine the incidence of TIA related acute infarction by DWI, and to determine the underlying predictors of DWI positivity in TIA patients. Methods: Between Jan 2017 and Dec 2018, we retrospectively enrolled 430 patients with a clinical diagnosis of TIA who underwent DWI. Patients were divided into those with acute ischemic lesions (DWI positive group) and those without (DWI negative group). The clinical characteristics, laboratory data, and imaging parameters were compared between the two groups. Results: A total of 430 time-based TIA patients (mean age, 61.4 ± 13.0) were enrolled in this study. About 126 (29.3%) of TIA patients had a DWI positive lesion in our series. Comparing TIA patients with positive DWI to those with negative DWI, acute lesions were more likely to be more male, have higher hyperlipidemia and a smoking history, more speech abnormalities and increased motor weakness; and higher systolic and diastolic blood pressure, homocysteine, fasting blood glucose, and the scores of ABCD2, ABCD3, ABCD3-I, and Dawson. Several independent predictors of DWI positivity were identified with logistic regression analysis: motor weakness (odds ratio 4.861, P = 0.021), speech abnormalities (odds ratio 4.029, P = 0.024), and ABCD3-I (odds ratio 13.141, P = 0.001). ABCD3-I showed the greatest area under the ROC curve, with a sensitivity of 85.7% and specificity of 72.4%. Conclusion: In patients with a clinical diagnosis of TIA, 29.3% demonstrated acute DWI lesions on brain magnetic resonance imaging (MRI). They were associated with motor weakness, speech abnormalities and higher ABCD3-I score at admission.
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Affiliation(s)
- Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zejin Jia
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yangguang Song
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Lu Y, Yu J, Hu J, Tan Y, Wu J, Zhao Y, Liu X. Predictive Value of A2HD Scoring for Transient Symptoms Associated with Infarction. Med Sci Monit 2019; 25:52-60. [PMID: 30601800 PMCID: PMC6327777 DOI: 10.12659/msm.911941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Effective early management of cerebral infarction patients with transient ischemic attack (TIA) is undermined by an inability to predict who is at highest risk of stroke. Material/Methods A total of 577 TIA patients with symptoms lasting no more than 1 hour were prospectively investigated and divided into a TIA group and a transient symptoms associated with infarction (TSI) group based on diffusion-weighted magnetic resonance imaging findings after hospital admission. The baseline characteristics, symptoms of TIA, features of disease onset, and findings from clinical examinations were compared between the 2 groups. Factors related to TSI were further analyzed. Results Of 577 TIA patients, 127 patients were in the TSI group and 450 were in the TIA group. Anterior circulation events, hemiplegia, aphasia, multiple seizures, maximal duration, atrial fibrillation, and hypointense plaques were included as risk factors for stroke in a model of multivariate analysis, and results showed that hemiplegia, aphasia, multiple seizures, and atrial fibrillation were independent risk factors for TSI. In the final mode, the area under the curve (AUC) was 0.766 (95% confidence interval: 0.729–0.800). According to the A2HD score and odds ratio, hemiplegia (score 2), aphasia (score 2), multiple seizures (score 2), and atrial fibrillation (score 1) were scored, and any increment in the score increased the risk for cerebral infarction by 1.893-fold (95% confidence interval: 1.643–2.181). Conclusions Risk of TSI seems to be highly predictable. The A2HD score can be used in clinical practice to identify high-risk cerebral infarction patients with TIA who need emergency diagnosis and treatment.
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Affiliation(s)
- You Lu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Jia Yu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Jian Hu
- Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Yan Tan
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Jiayan Wu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
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Lodha N, Harrell J, Eisenschenk S, Christou EA. Motor Impairments in Transient Ischemic Attack Increase the Odds of a Subsequent Stroke: A Meta-Analysis. Front Neurol 2017. [PMID: 28638365 PMCID: PMC5461338 DOI: 10.3389/fneur.2017.00243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background and purpose Transient ischemic attack (TIA) increases the risk for a subsequent stroke. Typical symptoms include motor weakness, gait disturbance, and loss of coordination. The association between the presence of motor impairments during a TIA and the chances of a subsequent stroke has not been examined. In the current meta-analysis, we examine whether the odds of a stroke are greater in TIA individuals who experience motor impairments as compared with those who do not experience motor impairments. Methods We conducted a systematic search of electronic databases as well as manual searches of the reference lists of retrieved articles. The meta-analysis included studies that reported an odds ratio relating motor impairments to a subsequent stroke, or the number of individuals with or without motor impairments who experienced a subsequent stroke. We examined these studies using rigorous meta-analysis techniques including random effects model, forest and funnel plots, I2, publication bias, and fail-safe analysis. Results Twenty-four studies with 15,129 participants from North America, Australia, Asia, and Europe qualified for inclusion. An odds ratio of 2.11 (95% CI, 1.67–2.65, p = 0.000) suggested that the chances of a subsequent stroke are increased by twofolds in individuals who experience motor impairments during a TIA compared with those individuals who have no motor impairments. Conclusion The presence of motor impairments during TIA is a significantly high-risk clinical characteristic for a subsequent stroke. The current evidence for motor impairments following TIA relies exclusively on the clinical reports of unilateral motor weakness. A comprehensive examination of motor impairments in TIA will enhance TIA prognosis and restoration of residual motor impairments.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Jane Harrell
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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13
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Purroy F, Cambray S, Mauri-Capdevila G, Jové M, Sanahuja J, Farré J, Benabdelhak I, Molina-Seguin J, Colàs-Campàs L, Begue R, Gil MI, Pamplona R, Portero-Otín M. Metabolomics Predicts Neuroimaging Characteristics of Transient Ischemic Attack Patients. EBioMedicine 2016; 14:131-138. [PMID: 27843094 PMCID: PMC5161417 DOI: 10.1016/j.ebiom.2016.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neuroimaging is essential for the diagnosis and prognosis of transient ischemic attack (TIA). The discovery of a plasmatic biomarker related to neuroimaging findings is of enormous interest because, despite its relevance, magnetic resonance diffusion weighted imaging (DWI) is not always available in all hospitals that attend to TIA patients. METHODS Metabolomic analyses were performed by liquid chromatography coupled to mass spectrometry in order to establish the metabolomic patterns of positive DWI, DWI patterns and acute ischemic lesion volumes. We used these methods with an initial TIA cohort of 129 patients and validated them with a 2nd independent cohort of 152 patients. FINDINGS Positive DWI was observed in 115 (40.9%) subjects and scattered pearls in one arterial territory was the most frequent lesion pattern (35.7%). The median acute ischemic lesion volume was 0.33 (0.15-1.90)cm3. We detected a specific metabolomic profile common to both cohorts for positive DWI (11 molecules including creatinine, threoninyl-threonine, N-acetyl-glucosamine, lyso phosphatidic acid and cholesterol-related molecules) and ischemic lesion volume (10 molecules including lysophosphatidylcholine, hypoxanthine/threonate, and leucines). Moreover lysophospholipids and creatinine clearly differed the subcortical DWI pattern from other patterns. INTERPRETATION There are specific metabolomic profiles associated with representative neuroimaging features in TIA patients. Our findings could allow the development of serum biomarkers related to acute ischemic lesions and specific acute ischemic patterns.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain.
| | - Serafi Cambray
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain
| | - Gerard Mauri-Capdevila
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain
| | - Mariona Jové
- NUTREN-Nutrigenomics Center, Department of Experimental Medicine, Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLLEIDA, Lleida, Spain
| | - Jordi Sanahuja
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain
| | - Joan Farré
- Laboratori Clinic, Universitari Arnau de Vilanova de Lleida, Clinical Neurosciences Group IRBLleida, Spain
| | - Ikram Benabdelhak
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain
| | - Jessica Molina-Seguin
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain
| | - Laura Colàs-Campàs
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain
| | - Robert Begue
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain
| | - M Isabel Gil
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Leida, Clinical Neurosciences Group IRBLleida, Spain
| | - Reinald Pamplona
- NUTREN-Nutrigenomics Center, Department of Experimental Medicine, Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLLEIDA, Lleida, Spain
| | - Manuel Portero-Otín
- NUTREN-Nutrigenomics Center, Department of Experimental Medicine, Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLLEIDA, Lleida, Spain
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Purroy F, Suárez-Luis I, Cambray S, Farré J, Benabdelhak I, Mauri-Capdevila G, Sanahuja J, Quílez A, Begué R, Gil MI, Molina-Seguin J, Torreguitart N. The determination of copeptin levels helps management decisions among transient ischaemic attack patients. Acta Neurol Scand 2016; 134:140-7. [PMID: 26471428 DOI: 10.1111/ane.12523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most approaches to transient ischaemic attack (TIA) triage use clinical scores and vascular imaging; however, some biomarkers have been suggested to improve the prognosis of TIA patients. METHODS Serum levels of copeptin, adiponectin, neopterin, neuron-specific enolase, high-sensitivity C-reactive protein, IL-6, N-terminal pro-B-type natriuretic peptide, S100β, tumour necrosis factor-alpha and IL-1α as well as clinical characteristics were assessed on consecutive TIA patients during the first 24 h of the onset of symptoms. RESULTS Among 237 consecutive TIA patients, 12 patients (5%) had a stroke within 7 days and 15 (6%) within 90 days. Among all candidate biomarkers analysed, only copeptin was significantly increased in patients with stroke recurrence (SR) within 7 days (P = 0.026) but not within 90 days. A cut-off point of 13.8 pmol/l was established with a great predictive negative value (97.4%). Large artery atherosclerosis (LAA) [hazard ratio (HR) 12.7, 95% CI 3.2-50.1, P < 0.001] and copeptin levels ≥13.8 pmol/l (HR 3.9, 95% CI 1.01-14.4, P = 0.039) were independent predictors of SR at the 7-day follow-up. LAA was the only predictor of 90-day SR (HR 7.4, 95% CI 2.5-21.6, P < 0.001). ABCD3I was associated with 7- and 90-day SRs (P = 0.025 and P = 0.034, respectively). The association between copeptin levels and LAA had a diagnostic accuracy of 90.3%. CONCLUSIONS Serum copeptin could be an important prognostic biomarker to guide management decisions among TIA patients. Therefore, TIA patients with copeptin levels below 13.8 pmol/l and without LAA have an insignificant risk of 7-day SR and could be managed on an outpatient basis.
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Affiliation(s)
- F. Purroy
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - I. Suárez-Luis
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - S. Cambray
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - J. Farré
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - I. Benabdelhak
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - G. Mauri-Capdevila
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - J. Sanahuja
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - A. Quílez
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - R. Begué
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - M. I. Gil
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - J. Molina-Seguin
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - N. Torreguitart
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
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Çakır Ç, Gençhellaç H, Temizöz O, Polat A, Şengül E, Duygulu G. Diffusion Weighted Magnetic Resonance Imaging for the Characterization of Solitary Pulmonary Lesions. Balkan Med J 2015; 32:403-9. [PMID: 26740901 DOI: 10.5152/balkanmedj.2015.15663] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/28/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We evaluated the differential diagnosis of solitary pulmonary lesions on magnetic resonance imaging. AIMS To investigate the value of diffusion weighted imaging on the differential diagnosis of solitary pulmonary lesions. STUDY DESIGN Randomized prospective study. METHODS This prospective study included 48 solitary pulmonary nodules and masses (18 benign, 30 malignant). Single shot echo planar spin echo diffusion weighted imaging (DWI) was performed with two b factors (0 and 1000 s/mm(2)). Apparent diffusion coefficients (ADCs) were calculated. On diffusion weighted (DW) trace images, the signal intensities (SI) of the lesions were visually compared to the SI of the thoracic spinal cord using a 5-point scale: 1: hypointense, 2: moderately hypointense, 3: isointense, 4: moderately hyperintense, 5: significantly hyperintense. For the quantitative evaluation, the lesion to thoracic spinal signal intensity ratios and the ADCs of the lesions were compared between groups. RESULTS On visual evaluation, taking the density of the spinal cord as a reference, most benign lesions were found to be hypointense, while most of the malignant lesions were evaluated as hyperintense on DWI with a b factor of 1000 s/mm(2). In contrast, on T2 weighted images, it was seen that the distinction of malignant lesions from benign lesions was not statistically significant. The ADCs of the malignant lesions were significantly lower than those of benign lesions (mean ADC was 2.02×10(-3) mm(2)/s for malignant lesions, and 1.195×10(-3)±0.3 mm(2)/s for benign lesions). Setting the cut-off value at 1.5×10(-3), ADC had a sensitivity of 86.7% and a specificity of 88.9% for the differentiation of benign lesions from malignant lesions. CONCLUSION DWI may aid in the differential diagnosis of solitary pulmonary lesions. (ClinicalTrials.gov Identifier: NCT02482181).
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Affiliation(s)
- Çağlayan Çakır
- Department of Radiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hakan Gençhellaç
- Department of Radiology, Trakya University Hospital, Edirne, Turkey
| | - Osman Temizöz
- Department of Radiology, Selçuk University Hospital, İzmir, Turkey
| | - Ahmet Polat
- Department of Radiology, Edirne State Hospital, Edirne, Turkey
| | - Ersin Şengül
- Department of Radiology, Trakya University Hospital, Edirne, Turkey
| | - Gökhan Duygulu
- Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
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16
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Hama Y, Uehara T, Ohara T, Kimura K, Okada Y, Hasegawa Y, Tanahashi N, Suzuki A, Takagi S, Nakagawara J, Arii K, Nagahiro S, Ogasawara K, Nagao T, Uchiyama S, Matsumoto M, Iihara K, Toyoda K, Minematsu K. Clinical Characteristics of Transient Ischemic Attack Patients with Atrial Fibrillation: Analyses of a Multicenter Retrospective Study. Cerebrovasc Dis Extra 2015; 5:84-90. [PMID: 26265911 PMCID: PMC4519611 DOI: 10.1159/000434689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/27/2015] [Indexed: 01/03/2023] Open
Abstract
Background Atrial fibrillation (AF) is an important risk factor for transient ischemic attack (TIA). However, little is known about the characteristics of TIA patients with AF. This study investigated the characteristics of such patients, using data from a retrospective, observational, multicenter study. Methods TIA patients admitted to 13 stroke centers in Japan within 7 days of onset between January 2008 and December 2009 were included. The present analyses compared baseline characteristics, clinical symptoms, findings from diffusion-weighted imaging (DWI), and clinical outcomes between patients with and without AF (AF and non-AF groups). Results A total of 464 patients (292 men; mean age 68.5 ± 13.2 years) were registered. Of these, 79 patients (17%) had AF. Patients in the AF group were older (73.9 ± 9.1 vs. 67.4 ± 13.6 years, p < 0.001) and more likely to show disturbance of consciousness (13 vs. 6%, p = 0.046) and aphasia (9 vs. 3%, p = 0.007) than patients in the non-AF group. Although no difference in the overall DWI-positive rate was seen between the groups (28 vs. 20%, p = 0.102), a single lesion (23 vs. 10%, p < 0.001), a lesion ≥15 mm (11 vs. 4%, p = 0.006), and a single lesion ≥15 mm (11 vs. 2%, p < 0.001) on DWI were more frequent in the AF group. Multivariate logistic regression analysis identified increased age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.02-1.07] and DWI single lesion ≥15 mm (OR 5.67; 95% CI 1.92-16.7) as independently associated with the presence of AF. Conclusions In this study, 17% of our TIA patients had AF. We found an association between the acute ischemic lesion pattern on DWI of a single lesion ≥15 mm and AF in TIA patients. These results might lead to a better diagnosis of TIA patients with AF.
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Affiliation(s)
- Yuka Hama
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Tokyo, Japan
| | - Toshiyuki Uehara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Tokyo, Japan
| | - Tomoyuki Ohara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Tokyo, Japan
| | - Kazumi Kimura
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Tokyo, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Tokyo, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Tokyo, Japan
| | - Norio Tanahashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, Saitama International Medical Center, Hidaka, Tokyo, Japan
| | - Akifumi Suzuki
- Department of Stroke Science, Research Institute for Brain and Blood Vessels Akita, Akita, Tokyo, Japan
| | - Shigeharu Takagi
- Department of Neurology, Tokai University, Isehara, Tokyo, Japan
| | - Jyoji Nakagawara
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Tokyo, Japan
| | - Kazumasa Arii
- Department of Neurology, Ebara Hospital, Tokyo, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Takehiko Nagao
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Tokyo, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Tokyo, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Tokyo, Japan
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Vilanova MB, Mauri-Capdevila G, Sanahuja J, Quilez A, Piñol-Ripoll G, Begué R, Gil MI, Codina-Barios MC, Benabdelhak I, Purroy F. Prediction of myocardial infarction in patients with transient ischaemic attack. Acta Neurol Scand 2015; 131:111-9. [PMID: 25302931 DOI: 10.1111/ane.12291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Determinants of risk of myocardial infarction (MI) after transient ischaemic attack (TIA) are not well defined. The aim of our study was to determine the risk and risk factors for MI after TIA. METHODS We prospectively recruited patients within 24 h of transient ischaemic cerebrovascular events between October 2006 and January 2013. A total of 628 TIA patients were followed for six months or more. MI and stroke recurrence (SR) were recorded. The duration and typology of clinical symptoms, vascular risk factors and aetiological work-ups were prospectively recorded and established prognostic scores (ABCD2, ABCD2I, ABCD3I, Essen Stroke Risk Score, California Risk Score and Stroke Prognosis Instrument) were calculated. RESULTS Twenty-eight (4.5%) MI and 68 (11.0%) recurrent strokes occurred during a median follow-up period of 31.2 months (16.1-44.9). In Cox proportional hazards multivariate analyses, we identify previous coronary heart disease (CHD) (hazard ratio [HR] 5.65, 95% confidence interval [CI] 2.45-13.04, P < 0.001) and sex male (HR 2.72, 95% CI 1.02-7.30, P = 0.046) as independent predictors of MI. Discrimination for the prognostic scores only ranged from 0.60 to 0.71. The incidence of MI did not vary among the different aetiological subtypes. Positive diffusion weighted imaging (DWI) (7.5% vs 2.5%, P = 0.007), and ECG abnormalities (Q wave or ST-T wave changes) (13.6% vs 3.6%, P = 0.001) were associated to MI. CONCLUSION According to our results, discrimination was poor for all previous risk prediction models evaluated. Variables such as previous CHD, male sex, DWI and ECG abnormalities should be considered in new prediction models.
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Affiliation(s)
- M. B. Vilanova
- Centre d'atenció primària Igualada Nord; Consorci Sanitari de l'Anoia; Igualada Spain
| | - G. Mauri-Capdevila
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - J. Sanahuja
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - A. Quilez
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - G. Piñol-Ripoll
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - R. Begué
- Institut de diagnòstic per la Imatge; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - M. I. Gil
- Institut de diagnòstic per la Imatge; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - M. C. Codina-Barios
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - I. Benabdelhak
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - F. Purroy
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
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Souillard-Scemama R, Tisserand M, Calvet D, Jumadilova D, Lion S, Turc G, Edjlali M, Mellerio C, Lamy C, Naggara O, Meder JF, Oppenheim C. An update on brain imaging in transient ischemic attack. J Neuroradiol 2015; 42:3-11. [DOI: 10.1016/j.neurad.2014.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
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Wardlaw J, Brazzelli M, Miranda H, Chappell F, McNamee P, Scotland G, Quayyum Z, Martin D, Shuler K, Sandercock P, Dennis M. An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation. Health Technol Assess 2014; 18:1-368, v-vi. [PMID: 24791949 DOI: 10.3310/hta18270] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patients with transient ischaemic attack (TIA) or minor stroke need rapid treatment of risk factors to prevent recurrent stroke. ABCD2 score or magnetic resonance diffusion-weighted brain imaging (MR DWI) may help assessment and treatment. OBJECTIVES Is MR with DWI cost-effective in stroke prevention compared with computed tomography (CT) brain scanning in all patients, in specific subgroups or as 'one-stop' brain-carotid imaging? What is the current UK availability of services for stroke prevention? DATA SOURCES Published literature; stroke registries, audit and randomised clinical trials; national databases; survey of UK clinical and imaging services for stroke; expert opinion. REVIEW METHODS Systematic reviews and meta-analyses of published/unpublished data. Decision-analytic model of stroke prevention including on a 20-year time horizon including nine representative imaging scenarios. RESULTS The pooled recurrent stroke rate after TIA (53 studies, 30,558 patients) is 5.2% [95% confidence interval (CI) 3.9% to 5.9%] by 7 days, and 6.7% (5.2% to 8.7%) at 90 days. ABCD2 score does not identify patients with key stroke causes or identify mimics: 66% of specialist-diagnosed true TIAs and 35-41% of mimics had an ABCD2 score of ≥ 4; 20% of true TIAs with ABCD2 score of < 4 had key risk factors. MR DWI (45 studies, 9078 patients) showed an acute ischaemic lesion in 34.3% (95% CI 30.5% to 38.4%) of TIA, 69% of minor stroke patients, i.e. two-thirds of TIA patients are DWI negative. TIA mimics (16 studies, 14,542 patients) make up 40-45% of patients attending clinics. UK survey (45% response) showed most secondary prevention started prior to clinic, 85% of primary brain imaging was same-day CT; 51-54% of patients had MR, mostly additional to CT, on average 1 week later; 55% omitted blood-sensitive MR sequences. Compared with 'CT scan all patients' MR was more expensive and no more cost-effective, except for patients presenting at > 1 week after symptoms to diagnose haemorrhage; strategies that triaged patients with low ABCD2 scores for slow investigation or treated DWI-negative patients as non-TIA/minor stroke prevented fewer strokes and increased costs. 'One-stop' CT/MR angiographic-plus-brain imaging was not cost-effective. LIMITATIONS Data on sensitivity/specificity of MR in TIA/minor stroke, stroke costs, prognosis of TIA mimics and accuracy of ABCD2 score by non-specialists are sparse or absent; all analysis had substantial heterogeneity. CONCLUSIONS Magnetic resonance with DWI is not cost-effective for secondary stroke prevention. MR was most helpful in patients presenting at > 1 week after symptoms if blood-sensitive sequences were used. ABCD2 score is unlikely to facilitate patient triage by non-stroke specialists. Rapid specialist assessment, CT brain scanning and identification of serious underlying stroke causes is the most cost-effective stroke prevention strategy. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Miriam Brazzelli
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Hector Miranda
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Francesca Chappell
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zahid Quayyum
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Duncan Martin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kirsten Shuler
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Jové M, Mauri-Capdevila G, Suárez I, Cambray S, Sanahuja J, Quílez A, Farré J, Benabdelhak I, Pamplona R, Portero-Otín M, Purroy F. Metabolomics predicts stroke recurrence after transient ischemic attack. Neurology 2014; 84:36-45. [PMID: 25471397 DOI: 10.1212/wnl.0000000000001093] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To discover, by using metabolomics, novel candidate biomarkers for stroke recurrence (SR) with a higher prediction power than present ones. METHODS Metabolomic analysis was performed by liquid chromatography coupled to mass spectrometry in plasma samples from an initial cohort of 131 TIA patients recruited <24 hours after the onset of symptoms. Pattern analysis and metabolomic profiling, performed by multivariate statistics, disclosed specific SR and large-artery atherosclerosis (LAA) biomarkers. The use of these methods in an independent cohort (162 subjects) confirmed the results obtained in the first cohort. RESULTS Metabolomics analyses could predict SR using pattern recognition methods. Low concentrations of a specific lysophosphatidylcholine (LysoPC[16:0]) were significantly associated with SR. Moreover, LysoPC(20:4) also arose as a potential SR biomarker, increasing the prediction power of age, blood pressure, clinical features, duration of symptoms, and diabetes scale (ABCD2) and LAA. Individuals who present early (<3 months) recurrence have a specific metabolomic pattern, differing from non-SR and late SR subjects. Finally, a potential LAA biomarker, LysoPC(22:6), was also described. CONCLUSIONS The use of metabolomics in SR biomarker research improves the predictive power of conventional predictors such as ABCD2 and LAA. Moreover, pattern recognition methods allow us to discriminate not only SR patients but also early and late SR cases.
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Affiliation(s)
- Mariona Jové
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Gerard Mauri-Capdevila
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Idalmis Suárez
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Serafi Cambray
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Jordi Sanahuja
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Alejandro Quílez
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Joan Farré
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Ikram Benabdelhak
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Reinald Pamplona
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Manuel Portero-Otín
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Francisco Purroy
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain.
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Kvistad CE, Logallo N, Thomassen L, Moen G, Waje-Andreassen U, Naess H. Diffusion-weighted lesions in stroke patients with transient symptoms--where are they located? Cerebrovasc Dis 2014; 38:219-25. [PMID: 25359097 DOI: 10.1159/000366264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND MR diffusion-weighted imaging (DWI) has revolutionized neuroimaging and contributed to a tissue-based redefinition of transient ischemic attack (TIA). Stroke patients with DWI lesions may have neurological symptoms that resolve completely within 24 h, suggesting successful vessel recanalization. Prior studies of stroke patients with transient symptoms have not found any predilection for DWI lesions in any specific territory. Other studies have, however, reported an association between higher brain dysfunction and presence of DWI lesions in patients with transient ischemic symptoms, suggesting a high rate of cortical affection in these patients. We sought to see whether DWI location in stroke patients with transient symptoms <24 h differed from those with persistent symptoms ≥ 24 h. We hypothesized an association between transient symptoms <24 h and cortical DWI lesion localization due to a possible higher rate of vessel recanalization in patients with transient symptoms causing distal cortical infarctions. METHODS Ischemic stroke patients examined with DWI and admitted within 24 h after symptom onset between February 2006 and November 2013 were prospectively registered in a database (The Bergen NORSTROKE Registry). Based on neurological examination 24 h after admission, patients were classified as having either transient symptoms <24 h (DWI <24) or persistent symptoms ≥ 24 h (DWI ≥ 24). DWI lesions were classified into different groups depending on lesion location: cortical lesions, confined to the supratentorial cortex; large subcortical lesions, located in the hemispheric white matter, basal ganglia, internal capsule, thalamus or corona radiate with a diameter ≥ 15 mm; lacunar lesions, located in the same territory as large subcortical lesions with a diameter <15 mm; mixed cortical-subcortical lesions, located in both supratentorial cortex and subcortex; cerebellar lesions, confined to the cerebellum; brain stem lesions, confined to the brain stem; multiple locations, located in more than one of the above defined areas. RESULTS A total of 142 ischemic stroke patients had DWI <24 and 830 DWI ≥ 24. Cortical DWI location was more frequent in patients with DWI <24 (54.2% vs. 29.5%, p < 0.001), while proportions of mixed cortical-subcortical lesions (13.4% vs. 26.5%, p = 0.001) and lesions with multiple locations (5.6% vs. 11.1%, p = 0.048) were less frequent as compared to DWI ≥ 24. Cortical DWI location was independently associated with DWI <24 when adjusted for confounders in multiple regression analyses (OR 1.89, 95% CI 1.28-2.81, p = 0.001). CONCLUSION Cortical DWI location was independently associated with transient stroke symptoms <24 h. This may be explained by vessel recanalization, resulting in upstream transportation of remaining particles and distal cortical lesions.
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Examination Timing and Lesion Patterns in Diffusion-weighted Magnetic Resonance Imaging of Patients with Classically Defined Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2013; 22:e310-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 11/15/2012] [Accepted: 12/12/2012] [Indexed: 11/20/2022] Open
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Purroy F, Suárez-Luis I, Mauri-Capdevila G, Cambray S, Farré J, Sanahuja J, Piñol-Ripoll G, Quílez A, González-Mingot C, Begué R, Gil MI, Fernández E, Benabdelhak I. N-terminal pro-brain natriuretic peptide level determined at different times identifies transient ischaemic attack patients with atrial fibrillation. Eur J Neurol 2013; 21:679-83. [PMID: 23800180 DOI: 10.1111/ene.12222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/24/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The etiological classification of patients with transient ischaemic attack (TIA) is a difficult endeavor and the use of serum biomarkers could improve the diagnostic accuracy. The aim of this study was to correlate atrial fibrillation, the main cardioembolic etiology (CE), with different serum biomarkers measured in consecutive TIA patients. METHODS The concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha, neuron-specific enolase, high-sensitivity C-reactive protein, IL-1-α and the N-terminal pro-B type natriuretic peptide (NT-proBNP) were quantified in the serum of 140 patients with TIA and 44 non-stroke subjects. Measurements were performed at different times throughout evolution: within 24 h of symptoms onset and at days 7 and 90. RESULTS With the exception of IL-6, all biomarkers were higher in TIA patients than in controls. NT-proBNP was significantly related to the presence or new diagnosis of AF at all time points analyzed. Furthermore, the baseline NT-proBNP level was significantly higher than values at the 7-day and 90-day follow-up. For this reason, different cut-off values were obtained at different times: 313 pg/ml at baseline [odds ratio (OR) = 18.99, P < 0.001], 181 pg/ml at 7 days (OR = 11.4, P = 0.001) and 174 pg/ml (OR = 8.46, P < 0.001) at 90 days. CONCLUSION High levels of NT-proBNP determined during the first 3 months after a TIA were associated with AF. Consequently, this biomarker may be useful to reclassify undetermined TIA patients as having disease of CE.
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Affiliation(s)
- F Purroy
- Stroke Unit, Hospital Universitari Arnau de Vilanova, Grup Neurociències Clíniques IRBLleida, Lleida, Spain
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Purroy F, Jiménez-Caballero PE, Mauri-Capdevila G, Torres MJ, Gorospe A, Ramírez Moreno JM, de la Ossa NP, Cánovas D, Arenillas J, Alvarez-Sabín J, Martínez Sánchez P, Fuentes B, Delgado-Mederos R, Martí-Fàbregas J, Rodríguez Campello A, Masjuán J. Predictive value of brain and vascular imaging including intracranial vessels in transient ischaemic attack patients: external validation of the ABCD3-I score. Eur J Neurol 2013; 20:1088-93. [PMID: 23530724 DOI: 10.1111/ene.12141] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Recently, brain and vascular imaging have been added to clinical variables to identify patients with transient ischaemic attack (TIA) with a high risk of stroke recurrence. The aim of our study was to externally validate the ABCD3-I score and the same score taking into account intracranial circulation. METHODS We analyzed data from 1137 patients with TIA from the PROMAPA study who underwent diffusion-weighted magnetic resonance imaging (DWI) within 7 days of symptom onset. Clinical variables and diagnostic work-up were recorded prospectively. The end-points were subsequent stroke at 7 and 90 days follow-up. RESULTS A total of 463 (40.7%) subjects fulfilled all inclusion criteria. During follow-up, eight patients (1.7%) had a stroke within 7 days, and 14 (3.1%) had a stroke within 3 months. In the Cox proportional hazard multivariate analyses, the combination of large-artery atherosclerosis and positive DWI remained as independent predictors of stroke recurrence at 7- and 90-day follow-up [HR 8.23, 95% confidence interval (CI) 2.89-23.46, P < 0.001]. The ABCD3-I score was a powerful predictor of subsequent stroke. The area under the receiver operating characteristic curve was 0.83 (95% CI 0.72-0.93) at 7 days and 0.69 (95% CI 0.53-0.85) at 90 days. When we include intracranial vessel disease in the score, the area under the curve increases but the difference observed was non-significant. CONCLUSION The inclusion of vascular and neuroimaging information to clinical scales (ABCD3-I score) provides important prognostic information and also helps management decisions, although it cannot give a complete distinction between high-risk and low-risk groups.
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Affiliation(s)
- F Purroy
- Stroke Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
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Andre JB, Zaharchuk G, Fischbein NJ, Augustin M, Skare S, Straka M, Rosenberg J, Lansberg MG, Kemp S, Wijman CAC, Albers GW, Schwartz NE, Bammer R. Clinical assessment of standard and generalized autocalibrating partially parallel acquisition diffusion imaging: effects of reduction factor and spatial resolution. AJNR Am J Neuroradiol 2012; 33:1337-42. [PMID: 22403781 DOI: 10.3174/ajnr.a2980] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE PI improves routine EPI-based DWI by enabling higher spatial resolution and reducing geometric distortion, though it remains unclear which of these is most important. We evaluated the relative contribution of these factors and assessed their ability to increase lesion conspicuity and diagnostic confidence by using a GRAPPA technique. MATERIALS AND METHODS Four separate DWI scans were obtained at 1.5T in 48 patients with independent variation of in-plane spatial resolution (1.88 mm(2) versus 1.25 mm(2)) and/or reduction factor (R = 1 versus R = 3). A neuroradiologist with access to clinical history and additional imaging sequences provided a reference standard diagnosis for each case. Three blinded neuroradiologists assessed scans for abnormalities and also evaluated multiple imaging-quality metrics by using a 5-point ordinal scale. Logistic regression was used to determine the impact of each factor on subjective image quality and confidence. RESULTS Reference standard diagnoses in the patient cohort were acute ischemic stroke (n = 30), ischemic stroke with hemorrhagic conversion (n = 4), intraparenchymal hemorrhage (n = 9), or no acute lesion (n = 5). While readers preferred both a higher reduction factor and a higher spatial resolution, the largest effect was due to an increased reduction factor (odds ratio, 47 ± 16). Small lesions were more confidently discriminated from artifacts on R = 3 images. The diagnosis changed in 5 of 48 scans, always toward the reference standard reading and exclusively for posterior fossa lesions. CONCLUSIONS PI improves DWI primarily by reducing geometric distortion rather than by increasing spatial resolution. This outcome leads to a more accurate and confident diagnosis of small lesions.
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Affiliation(s)
- J B Andre
- Department of Radiology, Stanford University, Stanford, California, USA.
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Purroy F, Montserrat J, Begué R, Gil MI, Quílez A, Sanahuja J, Brieva L, Pardina M, Piñol-Ripoll G. Higher Carotid Intima Media Thickness Predicts Extracranial Vascular Events and Not Stroke Recurrence among Transient Ischemic Attack Patients. Int J Stroke 2012; 7:125-32. [DOI: 10.1111/j.1747-4949.2011.00764.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Increased common carotid artery intima-media thickness has been associated with an increased risk of vascular ischemic events. We investigated the relationship between common carotid artery intima-media thickness and extracranial vascular events (coronary heart disease and peripheral arterial disease) or stroke recurrence in a cohort of transient ischemic attack patients from the REGITELL registry. Methods High-resolution B-mode ultrasonographic measurements of the common carotid artery intima-media thickness were performed in a series of 283 consecutive transient ischemic attack patients. Clinical, neuroimaging, ultrasonographic, and etiological data were collected. Patients were followed prospectively for six-months or more. Extracranial vascular events and stroke recurrence were recorded. Results Fifteen extracranial vascular events (12 coronary heart disease and three peripheral arterial disease) and 29 recurrent strokes occurred during a median follow-up period of 12·3 months. Patients who experienced extracranial vascular events had significantly ( P < 0·001) higher common carotid artery intima-media thickness values (1·087 (standard deviation 0·189) mm) than subjects who were free of extracranial vascular events (0·887 (standard deviation 0·195) mm). Nevertheless, common carotid artery intima-media thickness was not found to correlate with stroke recurrence. Cox proportional hazards multivariate analyses identified hypercholesterolemia (hazard ratio 6·87, 95% confidence interval: 1·93–24·39, P = 0·003) and common carotid artery intima-media thickness >0·939 mm (hazard ratio 8·90, 95% confidence interval: 2·00–39·49, P = 0·004) as independent predictors of extracranial vascular events after transient ischemic attack. Almost one of every three patients with hypercholesterolemia and high common carotid artery intima-media thickness had extracranial vascular events. Conclusions An elevated common carotid artery intima-media thickness value was associated with a higher long-term risk of extracranial vascular events but no with stroke recurrence. Hypercholesterolemia was the main risk factor for extracranial vascular events. The combination of hypercholesterolemia and common carotid artery intima-media thickness >0·939 mm justify the establishment of aggressive therapies and the study of subclinical coronary heart disease and peripheral arterial disease.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Josep Montserrat
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Robert Begué
- Institut de diagnòstic per la imatge, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Maria Isabel Gil
- Institut de diagnòstic per la imatge, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Alejandro Quílez
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Jordi Sanahuja
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Luis Brieva
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Marina Pardina
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
| | - Gerard Piñol-Ripoll
- Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA, Lleida, Spain
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Purroy F, Jiménez Caballero P, Gorospe A, Torres M, Álvarez-Sabin J, Santamarina E, Martínez-Sánchez P, Cánovas D, Freijo M, Egido J, Girón J, Ramírez-Moreno J, Alonso A, Rodríguez-Campello A, Casado I, Delgado-Medeiros R, Martí-Fàbregas J, Fuentes B, Silva Y, Quesada H, Cardona P, Morales A, de la Ossa N, García-Pastor A, Arenillas J, Segura T, Jiménez C, Masjuán J. Prediction of Early Stroke Recurrence in Transient Ischemic Attack Patients from the PROMAPA Study: A Comparison of Prognostic Risk Scores. Cerebrovasc Dis 2012; 33:182-9. [DOI: 10.1159/000334771] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2011] [Indexed: 11/19/2022] Open
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Fluri F, Jax F, Amort M, Wetzel SG, Lyrer PA, Katan M, Hatz F, Engelter ST. Significance of microbleeds in patients with transient ischaemic attack. Eur J Neurol 2011; 19:522-4. [PMID: 21951303 DOI: 10.1111/j.1468-1331.2011.03522.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to determine the prognostic significance of microbleeds in TIA-patients. In patients with a transient ischaemic attack (TIA), the prognostic value of microbleeds is unknown. METHODS In 176 consecutive TIA patients, the number, size, and location of microbleeds with or without acute ischaemic lesions were assessed. We compared microbleed-positive and microbleed-negative patients with regard to the end-point stroke within 3 months. RESULTS Four of the seven patients with subsequent stroke had microbleeds. Microbleed-positive patients had a higher risk for stroke [odds ratios (OR) 8.91, 95% CI 1.87-42.51, P<0.01] than those without microbleeds. Microbleed-positive patients with accompanying acute ischaemic lesions had a higher stroke risk than those with neither an acute ischaemia nor a microbleed (OR 6.20, 95% CI 1.10-35.12; P=0.04). CONCLUSION Microbleeds alone or in combination with acute ischaemic lesions may increase the risk for subsequent ischaemic stroke after TIA within 3 months.
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Affiliation(s)
- F Fluri
- Departments of Clinical Neurology Neuroradiology, University Hospital Basel, Basel, Switzerland
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