The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients.
OBJECTIVE
Some clinical models, like California ABCD and unified ABCD2 scores, are now available to predict the early risk of stroke after a TIA. Despite the transitivity of symptoms, DWI identified an area of acute brain ischemia in almost half of patients. It would be interesting to know how the presence of DWI abnormalities relates to clinical risk scores to plan other prognostic variables or to recommend the performance of DWI.


METHODS
We prospectively studied 135 consecutive TIA patients visited by the neurologists in our institution. All patients underwent DWI (3.8+/-1.7 days after symptoms onset). Clinical risk scores (California, ABCD, and ABCD2) were calculated prospectively for each patient. The identification of acute ischemic lesions (positive DWI) was related to the presence of clinical features and clinical risk scores.


RESULTS
DWI were positive in 67 (49.6%) patients. After Bonferroni adjustment, elevated ABCD, ABCD2, and California scores were not associated with a positive DWI. However, some clinical symptoms such as facial palsy and motor weakness were associated with a positive DWI (P<0.001). The logistic regression model identified only facial palsy as an independent predictor of acute ischemic lesions (odds ratio 6.26, 95% CI 2.49 to 15.71, P<0.001).


CONCLUSIONS
Clinical symptoms such as motor impairment, but not clinical risk scores, were associated with a positive DWI. Performing a DWI may add prognostic information to clinical risk scales as a predictor of stroke recurrence after TIA in future large studies.
Purroy
Francisco
F
Begué
Robert
R
Quílez
Alejandro
A
Piñol-Ripoll
Gerard
G
Sanahuja
Jordi
J
Brieva
Luis
L
Setó
Eloisa
E
Gil
Maria Isabel
MI
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005158:Facial Paralysis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology* / Q000473:pathology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D009069:Movement Disorders / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors