[Diagnostic lessons of recurrence pattern after transient ischemic attacks].
OBJECTIVE
Early stroke recurrence risk alter a transient ischemic attack (TIA) is high. We studied the diagnostic implications of the recurrence pattern after TIA.


METHODS
210 consecutive TIA patients were studied. Ultrasonographic (US), neuroimaging and cardiologic data were collected.


RESULTS
At 90 day follow-up, 14 patients (6.7%; 95% CI: 3.3-10.1) among 209 suffered an ischemic infarction (II), 9 (4.3%; 1.5-7.1) a TIA and 6 (2.9%; 0.6-5.1) a cardiac ischemic event. Moreover, 13 patients (6.2%; 2.8-9.6) among 210 with a seven-day follow-up had an II. Multivariate analyses only identified the presence of intracranial stenoses (HR, 23.29; 95% CI, 3.49 to 23.57; p<0.018) as independent predictors of stroke within the first 7 days, and large-artery occlusive disease (HR, 9.07; CI, 3.49 to 23.57; p<0.001) as a predictor of stroke recurrence at 90 day follow-up. A new diagnosis of atrial fibrillation was observed in 21 subjects (10.0%), and it was documented in the baseline ECG in 62% cases. Acute diffusion abnormalities were identified in 81 (44,5%) of 182 patients, and chronic ischemic lesions were observed in 110 (60.4%) on MRI vs 56 (26.7%) among 210 on CT scan.


CONCLUSIONS
Due to very early recurrence, the routine use of ultrasonography within the first hours after an index TIA will be useful to identify those patients at high risk. The prognostic usefulness of diffusion-weighted studies will be only achieved if it is performed early. Routine noninvasive cardiac rhythm monitoring has a low detection rate.
Purroy
Francisco
F
Sección de Neurología, Unidad de Ictus, Hospital Universitari Arnau de Vilanova de Lleida, Universitat de Lleida, IRBLLEIDA, Lleida, España. fpurroygarcia@gmail.com
Begué
Robert
R
Quílez
Alejandro
A
Piñol-Ripoll
Gerard
G
Sanahuja
Jordi
J
Brieva
Luis
L
Setó
Eloisa
E
Gil
Maria Isabel
MI
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000175:diagnosis; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography