Published Online
on July 5, 2007

A more recent version of this article appeared on August 1, 2007

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Submitted on October 12, 2006
Revised on December 10, 2006
Accepted on December 12, 2006

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; and 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.

^* To whom correspondence should be addressed. E-mail: ademchuk{at}ucalgary.ca.

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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