'Footprints' of transient ischemic attacks: a diffusion-weighted MRI study.
OBJECTIVE
Diffusion-weighted imaging (DWI) conveys temporal as well as anatomic information about brain infarction, and is therefore well suited to identify ischemic injury that has occurred simultaneously, or closely linked in time, with a transient ischemic attack (TIA). We aimed to determine the proportion and clinical characteristics of patients with TIA who harbor infarction(s) on DWI.


METHODS
Using T(2)-weighted imaging (T(2)-WI), fast fluid attenuated inversion recovery (FLAIR), and DWI, we studied 57 consecutive patients presenting with acute focal neurologic symptoms lasting less than 24 h.


RESULTS
A hyperintense DWI lesion was identified in a vascular territory appropriate to the symptoms in 27 patients (47%). Lesions judged to be clinically appropriate on T(2)-WI and FLAIR overlapped with a DWI lesion in 41 and 48% of patients, respectively. Independent predictors of infarction on DWI were previous nonstereotypic TIAs, presentation with motor symptoms, and identified stroke mechanism.


CONCLUSIONS
DWI establishes that recent infarction occurs in almost half of patients with the clinical syndrome of TIA and this subgroup is more likely to harbor an underlying cardiac or cerebrovascular abnormality.
Ay
Hakan
H
Stroke Service of the Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, Mass., USA. ayhmgh@hotmail.com
Oliveira-Filho
Jamary
J
Buonanno
Ferdinando S
FS
Schaefer
Pamela W
PW
Furie
Karen L
KL
Chang
Yuchiao Chang
YC
Rordorf
Guy
G
Schwamm
Lee H
LH
Gonzalez
R Gilberto
RG
Koroshetz
Walter J
WJ
D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis; D002544:Cerebral Infarction / Q000175:diagnosis; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method