title: Juxtacortical spots on fluid-attenuated inversion recovery images in cryptogenic transient ischemic attack.
abstract: OBJECTIVE
  Juxtacortical spots are detected frequently on fluid-attenuated inversion recovery (FLAIR) images, but have not been extensively researched in patients with transient ischemic attack (TIA). We hypothesized that juxtacortical spots on FLAIR images are partly associated with right-to-left shunt (RLS) in TIA without clear etiology. The possibility of an association between the presence of RLS and juxtacortical spots on FLAIR images in patients with TIA without clear etiology was investigated, and the imaging findings of patients with and without RLS were compared.
  
  
  METHODS
  This was a retrospective study of TIA patients who visited our tertiary stroke center consecutively within 72 hours of TIA onset. Cryptogenic TIA was defined as no clear etiology despite a routine diagnostic workup. The presence of RLS was examined by transcranial Doppler with an agitated saline test or transesophageal echocardiography. Juxtacortical spots were defined as small and round hyperintensities in the juxtacortex on FLAIR images, excluding white-matter hyperintensities.
  
  
  RESULTS
  Of the 132 patients with cryptogenic TIA examined for this study, 70 (53.0%) had RLS. Juxtacortical spots on FLAIR images were detected more frequently in patients with RLS than in those without. The independent factors for the presence of juxtacortical spots were RLS [odds ratio (OR)=3.802, 95% confidence interval (95% CI)=1.74-8.2; p=0.001] and age (OR=1.058, 95% CI=1.01-1.10; p=0.004) by multivariate analysis. The number of juxtacortical spots was significantly higher among patients with a moderate-to-large RLS than in those with a small or no RLS.
  
  
  CONCLUSIONS
  The findings of the present study demonstrate a significant association between the presence of RLS and the occurrence of juxtacortical spots on FLAIR images in patients with cryptogenic TIA.
authors.affiliation: Department of Neurology, Cerebrovascular Center, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Dong-Eun
authors.initials: DE
authors.lastname: Kim
authors.forename: Min-Ji
authors.initials: MJ
authors.lastname: Choi
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.forename: Jane
authors.initials: J
authors.lastname: Chang
authors.forename: Seong-Min
authors.initials: SM
authors.lastname: Choi
authors.forename: Seung-Han
authors.initials: SH
authors.lastname: Lee
authors.forename: Man-Seok
authors.initials: MS
authors.lastname: Park
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
keywords: FLAIR; TIA; deep white-matter lesions; juxtacortical spots; patent foramen ovale; right-to-left shunt