Published Online
on November 13, 2003

A more recent version of this article appeared on December 1, 2003

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Submitted on August 14, 2003
Accepted on August 26, 2003

Head Computed Tomography Findings Predict Short-Term Stroke Risk After Transient Ischemic Attack

Vanja C. Douglas BS; Clarissa M. Johnston MD^*; Jacob Elkins MD; Stephen Sidney MD, MPH; Daryl R. Gress MD; and S. Claiborne Johnston MD, PhD

From the Department of Neurology, University of California, San Francisco (V.C.D, S.C.J., J.E.); Kaiser Permanente Medical Group, San Francisco, Calif (C.M.J.); Kaiser Permanente Division of Research, Oakland, Calif (S.S.); and Lynchburg Neurology Association, Lynchburg, Va (D.R.G.).

^* To whom correspondence should be addressed. E-mail: clay.johnston{at}ucsfmedctr.org.

Background and Purpose--Current guidelines recommend the use of head CT in the evaluation of patients with transient ischemic attack (TIA), but data supporting its value are sparse.

Methods--Patients who presented to 1 of 16 emergency departments of a large Northern California health maintenance organization and received a diagnosis of TIA from November 1997 through February 1998 were enrolled and followed up for 90 days. Clinical, demographic, and outcome data were obtained from computerized databases and medical records. Physicians blinded to patient characteristics and outcomes abstracted head CT findings from radiology reports. Abstracted findings included evidence of old or new infarct, periventricular white-matter disease, cerebral atrophy, cerebral vascular calcification, and nonischemic lesions.

Results--Head CT was performed in 67% of eligible patients (n=322) diagnosed with TIA. Evidence of a new infarct was seen on head CT in 13 patients (4%). A nonischemic cause of TIA symptoms was found in 4 patients (1.2%). During follow-up, 10.9% of TIA patients experienced subsequent stroke. After adjustment for confounders, risk for stroke during follow-up was significantly higher in those with a new infarct on head CT compared with others with TIA (odds ratio, 4.06; 95% confidence interval, 1.16 to 14.14; P=0.028). Old infarction, periventricular white-matter disease, cerebral atrophy, and cerebral vascular calcification were not predictors of subsequent risk of stroke.

Conclusions--Evidence of a new infarct on head CT in patients presenting with TIA is associated with increased short-term risk for stroke. Head CT appears to have prognostic value in patients with TIA and, for this reason alone, may be justified in their evaluation.

Key words: cerebral ischemia, transient • cerebrovascular accident • computed tomography

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