Early Stroke Risk after Transient Ischemic Attack in Patients without Large-Artery Disease or Atrial Fibrillation.
BACKGROUND
Patients with transient ischemic attack (TIA) without large-artery disease (LAD) or atrial fibrillation (AF) on admission may be at higher risk of stroke than previously thought. The aim of this study was to investigate early stroke risk and its predictors in such patients.


METHODS
We studied 410 TIA patients admitted to our institute within 48 hours of onset. Urgent etiological workup revealed that 210 patients had neither symptomatic LAD nor AF. The outcome measure was the stroke occurrence within 7 days after admission.


RESULTS
Stroke occurred within 7 days in 15 patients, 7.1% of patients without LAD or AF and 6.5% of those with LAD or AF, showing no statistical difference between the 2 groups. Twelve of the 15 patients were diagnosed with small-vessel disease as the stroke etiology. In multivariable regression analysis, motor lacunar symptoms (odds ratio [OR], 5.7; 95% confidence interval [CI], 1.4-41.1), high systolic blood pressure on admission of 183 mm Hg or greater (OR, 15.3; 95% CI, 3.8-80.2), and positive diffusion-weighted imaging findings (OR, 6.1; 95% CI, 1.6-28.1) were independent predictors for the stroke occurrence within 7 days in patients without LAD or AF.


CONCLUSIONS
TIA patients should be cautiously managed, even when neither LAD nor AF are identified by urgent workup. Clinical findings as motor lacunar symptom or high admission blood pressure, besides diffusion-weighted imaging findings, may be helpful to predict early stroke in such patients.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: ohar21@gmail.com.
Tomoyuki
T
Ohara
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Toshiyuki
T
Uehara
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Kazunori
K
Toyoda
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Rieko
R
Suzuki
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Shoichiro
S
Sato
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Kazuyuki
K
Nagatsuka
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Kazuo
K
Minematsu
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D016009:Chi-Square Distribution; D038524:Diffusion Magnetic Resonance Imaging; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D007564:Japan; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors
Transient ischemic attack; capsular warning syndrome; lacunar TIA; small vessel disease; stroke risk