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(Stroke. 2009;40:2229.)
© 2009 American Heart Association, Inc.

Research Letters

The California, ABCD, and Unified ABCD2 Risk Scores and the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging in TIA Patients

Francisco Purroy, MD, PhD; Robert Begué, MD; Alejandro Quílez, MD; Gerard Piñol-Ripoll, MD, PhD; Jordi Sanahuja, MD; Luis Brieva, MD; Eloisa Setó, MD Maria Isabel Gil, MD

From the Stroke Unit, Department of Neurology (F.P., A.Q., G.P.-R., J.S., L.B., E.S.) Universitat de Lleida, and Institut de diagnòstic per la imatge (R.B., M.I.G.), Hospital Universitari Arnau de Vilanova de Lleida, Biomedical Research Institute of Lleida (IRBLLEIDA), Spain.

Correspondence to Francisco Purroy, MD, PhD, Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, Avda Rovira Roure, 80, Lleida 25198, Spain. E-mail fpurroygarcia{at}gmail.com

Background and Purpose— Some clinical models, like California ABCD and unified ABCD2 scores, are now available to predict the early risk of stroke after a TIA. Despite the transitivity of symptoms, DWI identified an area of acute brain ischemia in almost half of patients. It would be interesting to know how the presence of DWI abnormalities relates to clinical risk scores to plan other prognostic variables or to recommend the performance of DWI.

Methods— We prospectively studied 135 consecutive TIA patients visited by the neurologists in our institution. All patients underwent DWI (3.8±1.7 days after symptoms onset). Clinical risk scores (California, ABCD, and ABCD2) were calculated prospectively for each patient. The identification of acute ischemic lesions (positive DWI) was related to the presence of clinical features and clinical risk scores.

Results— DWI were positive in 67 (49.6%) patients. After Bonferroni adjustment, elevated ABCD, ABCD2, and California scores were not associated with a positive DWI. However, some clinical symptoms such as facial palsy and motor weakness were associated with a positive DWI (P<0.001). The logistic regression model identified only facial palsy as an independent predictor of acute ischemic lesions (odds ratio 6.26, 95% CI 2.49 to 15.71, P<0.001).

Conclusion— Clinical symptoms such as motor impairment, but not clinical risk scores, were associated with a positive DWI. Performing a DWI may add prognostic information to clinical risk scales as a predictor of stroke recurrence after TIA in future large studies.

Key Words: ischemic attack • transient • magnetic resonance imaging • diffusion magnetic resonance imaging