Transient ischemic attack with infarction: a unique syndrome?
It is debated whether transient symptoms associated with infarction (TSI) are best considered a minor ischemic stroke, a subtype of transient ischemic attack (TIA), or a separate ischemic brain syndrome. We studied clinical and imaging features to establish similarities and differences among ischemic stroke, TIA without infarction, and TSI. Eighty-seven consecutive patients with TIA and 74 patients with ischemic stroke were studied. All underwent diffusion-weighted imaging on admission. Symptom duration and infarct volume were determined in each group. Thirty-six patients (41.3%) with TIA had acute infarct(s). Although TIA-related infarcts were smaller than those associated with ischemic stroke (mean, 0.7 vs 27.3 ml; p < 0.001), there was no lesion size threshold that distinguished ischemic stroke from TSI. In contrast, the symptom duration probability density curve was not broad, but instead peaked early with only a few patients having symptoms for longer than 200 minutes. The probability density function for symptom duration was similar between TIA with or without infarction. The in-hospital recurrent ischemic stroke and TIA rate was 19.4% in patients with TSI and 1.3% in those with ischemic stroke. TIA with infarction appears to have unique features separate from TIA without infarction and ischemic stroke. We propose identifying TSI as a separate clinical syndrome with distinct prognostic features.
Ay
Hakan
H
Department of A. A. Martinos Center for Biomedical Imaging and Stroke Service, Department of Radiology, Boston, MA 02129, USA. hay@partners.org
Koroshetz
Walter J
WJ
Benner
Thomas
T
Vangel
Mark G
MG
Wu
Ona
O
Schwamm
Lee H
LH
Sorensen
A Gregory
AG
D000368:Aged; D001921:Brain / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications* / Q000473:pathology; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010641:Phenotype; D011379:Prognosis; D013577:Syndrome