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(Stroke. 2007;38:2367.)
© 2007 American Heart Association, Inc.

Research Letters

Diffusion-Weighted Imaging-Negative Patients With Transient Ischemic Attack Are at Risk of Recurrent Transient Events

Jean-Martin Boulanger, MD, FRCPC; Shelagh B. Coutts, MD, FRCPC; Michael Eliasziw, PhD; Suresh Subramaniam, MD; James Scott, MD, FRCPC Andrew M. Demchuk, MD, FRCPC

From the Seaman Family MR Research Centre (J.-M.B., S.B.C., S.S., A.M.D.), Foothills Medical Centre, Calgary Health Region, Calgary, Alberta, Canada; and the Departments of Clinical Neurosciences (J.-M.B., S.B.C., M.E., S.S., A.M.D.), Community Health Sciences (M.E.), and Radiology (J.S.), University of Calgary, Calgary, Alberta, Canada.

Correspondence to Andrew M. Demchuk, MD, FRCPC, Room 1162, 1403 29th St. NW, Foothills Hospital, Calgary, Alberta, T2N 2T9, Canada. E-mail ademchuk{at}ucalgary.ca

Abstract

Background and Purpose— Among patients presenting with a transient ischemic attack (TIA), some clinical features predispose to recurrent TIA, whereas others predispose to subsequent strokes. We assessed the implication of negative diffusion-weighted imaging on a baseline MRI in predicting subsequent TIA.

Methods— We prospectively studied patients presenting in the emergency department within 12 hours of a TIA (motor or speech). All patients had a MRI within 24 hours of the index event. The primary outcome was TIA within 1 year of study entry. The 1-year risk of stroke was also evaluated.

Results— A total of 85 patients had a MRI, among which 35 patients (41.2%) had a diffusion-weighted imaging lesion. The mean time from symptom onset to MRI was 12.1 hours. Patients without a diffusion-weighted imaging lesion on baseline MRI were 4.6 times (27.4% versus 5.9%; P<0.05) more likely to have a subsequent TIA at 1 year than patients with a diffusion-weighted imaging lesion, but 4.3 times (2.1% versus 9.1%; P=0.19) less likely to have a subsequent stroke.

Conclusions— The absence of a diffusion-weighted imaging lesion on the baseline scan predicts recurrent transient events rather than stroke.

Key Words: brain infarction • ischemic stroke • magnetic resonance imaging • transient ischemic attack

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