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Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic
Background This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemi...
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| Published in: | Journal of the American Heart Association 2022-02, Vol.11 (3), p.e024191-e024191 |
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| creator | Epstein, Alessandra Schilter, Marina Vynckier, Jan Kaesmacher, Johannes Mujanovic, Adnan Scutelnic, Adrian Beyeler, Morin Belachew, Nebiyat Filate Grunder, Lorenz Arnold, Marcel Seiffge, David Julian Jung, Simon Fischer, Urs Meinel, Thomas Raphael |
| description | Background This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemic stroke. Methods and Results Single-center cohort study including consecutive patients with TIA, stroke mimics, and acute ischemic stroke, with available magnetic resonance imaging from January 2015 to December 2017. Blinded raters adjudicated WMH (age-related white matter changes score) and CBI according to established definitions. A total of 2112 patients (median [Q1-Q3] age 71 [59-80] years, 43% women, National Institutes of Health Stroke Scale score of 2 [1-7], 80% ischemic stroke, 18% TIA, 2% stroke mimics) were included. While CBIs were present in only 10% of patients with stroke mimic, they were detected in 28% of TIAs and 38% of ischemic strokes ( |
| doi_str_mv | 10.1161/JAHA.121.024191 |
| format | article |
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<0.001). WMHs were less pronounced (0, 0-1) in patients with stroke mimic, but there was no difference between TIA (1, 1-2) and ischemic stroke (0, 1-2) patients. CBIs (adjusted odds ratio, 0.3; 95% CI, 0.1-0.9) were associated with a lower rate of stroke mimic as the final diagnosis, while WMHs were not (adjusted odds ratio per point, 1.3; 95% CI, 0.7-2.2). WMH (β per point, 0.4; 95% CI, 0.3-0.6) and presence of CBI (β, 0.6; 95% CI, 0.3-0.9) were associated with a higher cardiovascular risk profile according to the ABCD3-I score. The accuracy of prediction was good for high-risk TIA (cross-validated area under the receiver operating characteristic curve, 0.89; 95% CI, 0.79-0.93) on the basis of brain imaging, age, and sex. Conclusions CBI and WMH differ between patients with stroke mimic and patients with TIA/ischemic stroke and are closely associated with established recurrence risk scores. Prospective studies need to clarify whether including brain frailty markers may contribute to the refinement of current management algorithms and risk stratifications.</description><identifier>ISSN: 2047-9980</identifier><identifier>EISSN: 2047-9980</identifier><identifier>DOI: 10.1161/JAHA.121.024191</identifier><identifier>PMID: 35043677</identifier><language>eng</language><publisher>England: John Wiley and Sons Inc</publisher><subject>Aged ; Brain Infarction ; Brief Communication ; Cohort Studies ; covert brain infarction ; Female ; Humans ; Ischemic Attack, Transient - complications ; Ischemic Attack, Transient - diagnosis ; Ischemic Attack, Transient - epidemiology ; Ischemic Stroke ; Leukoaraiosis ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; Risk Factors ; Stroke - complications ; Stroke - diagnosis ; Stroke - epidemiology ; stroke mimic ; transient ischemic attack ; White Matter - diagnostic imaging ; White Matter - pathology ; white matter hyperintensities</subject><ispartof>Journal of the American Heart Association, 2022-02, Vol.11 (3), p.e024191-e024191</ispartof><rights>2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-968b0eb0e5f1f2c5bfa8760e46529a4420b5e6b882c071bf2330fab8f40edef13</citedby><cites>FETCH-LOGICAL-c459t-968b0eb0e5f1f2c5bfa8760e46529a4420b5e6b882c071bf2330fab8f40edef13</cites><orcidid>0000-0001-5911-7957 ; 0000-0001-9053-584X ; 0000-0002-0647-9273 ; 0000-0001-5338-961X ; 0000-0003-0521-4051 ; 0000-0002-6839-7134 ; 0000-0001-5285-5922 ; 0000-0003-3890-3849 ; 0000-0002-9177-2289 ; 0000-0003-0511-8422</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238476/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238476/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35043677$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Epstein, Alessandra</creatorcontrib><creatorcontrib>Schilter, Marina</creatorcontrib><creatorcontrib>Vynckier, Jan</creatorcontrib><creatorcontrib>Kaesmacher, Johannes</creatorcontrib><creatorcontrib>Mujanovic, Adnan</creatorcontrib><creatorcontrib>Scutelnic, Adrian</creatorcontrib><creatorcontrib>Beyeler, Morin</creatorcontrib><creatorcontrib>Belachew, Nebiyat Filate</creatorcontrib><creatorcontrib>Grunder, Lorenz</creatorcontrib><creatorcontrib>Arnold, Marcel</creatorcontrib><creatorcontrib>Seiffge, David Julian</creatorcontrib><creatorcontrib>Jung, Simon</creatorcontrib><creatorcontrib>Fischer, Urs</creatorcontrib><creatorcontrib>Meinel, Thomas Raphael</creatorcontrib><title>Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic</title><title>Journal of the American Heart Association</title><addtitle>J Am Heart Assoc</addtitle><description>Background This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemic stroke. Methods and Results Single-center cohort study including consecutive patients with TIA, stroke mimics, and acute ischemic stroke, with available magnetic resonance imaging from January 2015 to December 2017. Blinded raters adjudicated WMH (age-related white matter changes score) and CBI according to established definitions. A total of 2112 patients (median [Q1-Q3] age 71 [59-80] years, 43% women, National Institutes of Health Stroke Scale score of 2 [1-7], 80% ischemic stroke, 18% TIA, 2% stroke mimics) were included. While CBIs were present in only 10% of patients with stroke mimic, they were detected in 28% of TIAs and 38% of ischemic strokes (
<0.001). WMHs were less pronounced (0, 0-1) in patients with stroke mimic, but there was no difference between TIA (1, 1-2) and ischemic stroke (0, 1-2) patients. CBIs (adjusted odds ratio, 0.3; 95% CI, 0.1-0.9) were associated with a lower rate of stroke mimic as the final diagnosis, while WMHs were not (adjusted odds ratio per point, 1.3; 95% CI, 0.7-2.2). WMH (β per point, 0.4; 95% CI, 0.3-0.6) and presence of CBI (β, 0.6; 95% CI, 0.3-0.9) were associated with a higher cardiovascular risk profile according to the ABCD3-I score. The accuracy of prediction was good for high-risk TIA (cross-validated area under the receiver operating characteristic curve, 0.89; 95% CI, 0.79-0.93) on the basis of brain imaging, age, and sex. Conclusions CBI and WMH differ between patients with stroke mimic and patients with TIA/ischemic stroke and are closely associated with established recurrence risk scores. Prospective studies need to clarify whether including brain frailty markers may contribute to the refinement of current management algorithms and risk stratifications.</description><subject>Aged</subject><subject>Brain Infarction</subject><subject>Brief Communication</subject><subject>Cohort Studies</subject><subject>covert brain infarction</subject><subject>Female</subject><subject>Humans</subject><subject>Ischemic Attack, Transient - complications</subject><subject>Ischemic Attack, Transient - diagnosis</subject><subject>Ischemic Attack, Transient - epidemiology</subject><subject>Ischemic Stroke</subject><subject>Leukoaraiosis</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Stroke - complications</subject><subject>Stroke - diagnosis</subject><subject>Stroke - epidemiology</subject><subject>stroke mimic</subject><subject>transient ischemic attack</subject><subject>White Matter - diagnostic imaging</subject><subject>White Matter - pathology</subject><subject>white matter hyperintensities</subject><issn>2047-9980</issn><issn>2047-9980</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpVkk1vGyEQhldVqyZKc-6t4thD7PC1LFwquVZbu0rUSk2VI2LZIUtigws4Un5B_3ZJNo0ShMRo5p1nQLxN857gOSGCnH5frBZzQskcU04UedUcUsy7mVISv34WHzTHOV_jugTtWKveNgesxZyJrjts_i7HFIO3aBlvIRX0ORkf0Do4k2zxMWRkwoAuR18AnZtSIKHV3Q6SDwVC9sVDRrXhp6lRKBld-jKiXyXFGzhBF8lUTc2jdbYjbOuYRSnG3pw8UCcZOve18K5548wmw_HjedT8_vrlYrmanf34tl4uzmaWt6rMlJA9hrpbRxy1be-M7AQGLlqqDOcU9y2IXkpqcUd6RxnDzvTScQwDOMKOmvXEHaK51rvktybd6Wi8fkjEdKVNKt5uQPccqGyplD0I7qwyQhpWkbQFLNrBVdanibXb91sYbH1oMpsX0JeV4Ed9FW-1okzyTlTAx0dAin_2kIve-mxhszEB4j5rKiihXEmGq_R0ktoUc07gnsYQrO_doO_doKsb9OSG2vHh-e2e9P__nv0D1U6yRw</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Epstein, Alessandra</creator><creator>Schilter, Marina</creator><creator>Vynckier, Jan</creator><creator>Kaesmacher, Johannes</creator><creator>Mujanovic, Adnan</creator><creator>Scutelnic, Adrian</creator><creator>Beyeler, Morin</creator><creator>Belachew, Nebiyat Filate</creator><creator>Grunder, Lorenz</creator><creator>Arnold, Marcel</creator><creator>Seiffge, David Julian</creator><creator>Jung, Simon</creator><creator>Fischer, Urs</creator><creator>Meinel, Thomas Raphael</creator><general>John Wiley and Sons Inc</general><general>Wiley</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-5911-7957</orcidid><orcidid>https://orcid.org/0000-0001-9053-584X</orcidid><orcidid>https://orcid.org/0000-0002-0647-9273</orcidid><orcidid>https://orcid.org/0000-0001-5338-961X</orcidid><orcidid>https://orcid.org/0000-0003-0521-4051</orcidid><orcidid>https://orcid.org/0000-0002-6839-7134</orcidid><orcidid>https://orcid.org/0000-0001-5285-5922</orcidid><orcidid>https://orcid.org/0000-0003-3890-3849</orcidid><orcidid>https://orcid.org/0000-0002-9177-2289</orcidid><orcidid>https://orcid.org/0000-0003-0511-8422</orcidid></search><sort><creationdate>20220201</creationdate><title>Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic</title><author>Epstein, Alessandra ; Schilter, Marina ; Vynckier, Jan ; Kaesmacher, Johannes ; Mujanovic, Adnan ; Scutelnic, Adrian ; Beyeler, Morin ; Belachew, Nebiyat Filate ; Grunder, Lorenz ; Arnold, Marcel ; Seiffge, David Julian ; Jung, Simon ; Fischer, Urs ; Meinel, Thomas Raphael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-968b0eb0e5f1f2c5bfa8760e46529a4420b5e6b882c071bf2330fab8f40edef13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Brain Infarction</topic><topic>Brief Communication</topic><topic>Cohort Studies</topic><topic>covert brain infarction</topic><topic>Female</topic><topic>Humans</topic><topic>Ischemic Attack, Transient - complications</topic><topic>Ischemic Attack, Transient - diagnosis</topic><topic>Ischemic Attack, Transient - epidemiology</topic><topic>Ischemic Stroke</topic><topic>Leukoaraiosis</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Stroke - complications</topic><topic>Stroke - diagnosis</topic><topic>Stroke - epidemiology</topic><topic>stroke mimic</topic><topic>transient ischemic attack</topic><topic>White Matter - diagnostic imaging</topic><topic>White Matter - pathology</topic><topic>white matter hyperintensities</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Epstein, Alessandra</creatorcontrib><creatorcontrib>Schilter, Marina</creatorcontrib><creatorcontrib>Vynckier, Jan</creatorcontrib><creatorcontrib>Kaesmacher, Johannes</creatorcontrib><creatorcontrib>Mujanovic, Adnan</creatorcontrib><creatorcontrib>Scutelnic, Adrian</creatorcontrib><creatorcontrib>Beyeler, Morin</creatorcontrib><creatorcontrib>Belachew, Nebiyat Filate</creatorcontrib><creatorcontrib>Grunder, Lorenz</creatorcontrib><creatorcontrib>Arnold, Marcel</creatorcontrib><creatorcontrib>Seiffge, David Julian</creatorcontrib><creatorcontrib>Jung, Simon</creatorcontrib><creatorcontrib>Fischer, Urs</creatorcontrib><creatorcontrib>Meinel, Thomas Raphael</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Journal of the American Heart Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Epstein, Alessandra</au><au>Schilter, Marina</au><au>Vynckier, Jan</au><au>Kaesmacher, Johannes</au><au>Mujanovic, Adnan</au><au>Scutelnic, Adrian</au><au>Beyeler, Morin</au><au>Belachew, Nebiyat Filate</au><au>Grunder, Lorenz</au><au>Arnold, Marcel</au><au>Seiffge, David Julian</au><au>Jung, Simon</au><au>Fischer, Urs</au><au>Meinel, Thomas Raphael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic</atitle><jtitle>Journal of the American Heart Association</jtitle><addtitle>J Am Heart Assoc</addtitle><date>2022-02-01</date><risdate>2022</risdate><volume>11</volume><issue>3</issue><spage>e024191</spage><epage>e024191</epage><pages>e024191-e024191</pages><issn>2047-9980</issn><eissn>2047-9980</eissn><abstract>Background This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemic stroke. Methods and Results Single-center cohort study including consecutive patients with TIA, stroke mimics, and acute ischemic stroke, with available magnetic resonance imaging from January 2015 to December 2017. Blinded raters adjudicated WMH (age-related white matter changes score) and CBI according to established definitions. A total of 2112 patients (median [Q1-Q3] age 71 [59-80] years, 43% women, National Institutes of Health Stroke Scale score of 2 [1-7], 80% ischemic stroke, 18% TIA, 2% stroke mimics) were included. While CBIs were present in only 10% of patients with stroke mimic, they were detected in 28% of TIAs and 38% of ischemic strokes (
<0.001). WMHs were less pronounced (0, 0-1) in patients with stroke mimic, but there was no difference between TIA (1, 1-2) and ischemic stroke (0, 1-2) patients. CBIs (adjusted odds ratio, 0.3; 95% CI, 0.1-0.9) were associated with a lower rate of stroke mimic as the final diagnosis, while WMHs were not (adjusted odds ratio per point, 1.3; 95% CI, 0.7-2.2). WMH (β per point, 0.4; 95% CI, 0.3-0.6) and presence of CBI (β, 0.6; 95% CI, 0.3-0.9) were associated with a higher cardiovascular risk profile according to the ABCD3-I score. The accuracy of prediction was good for high-risk TIA (cross-validated area under the receiver operating characteristic curve, 0.89; 95% CI, 0.79-0.93) on the basis of brain imaging, age, and sex. Conclusions CBI and WMH differ between patients with stroke mimic and patients with TIA/ischemic stroke and are closely associated with established recurrence risk scores. Prospective studies need to clarify whether including brain frailty markers may contribute to the refinement of current management algorithms and risk stratifications.</abstract><cop>England</cop><pub>John Wiley and Sons Inc</pub><pmid>35043677</pmid><doi>10.1161/JAHA.121.024191</doi><orcidid>https://orcid.org/0000-0001-5911-7957</orcidid><orcidid>https://orcid.org/0000-0001-9053-584X</orcidid><orcidid>https://orcid.org/0000-0002-0647-9273</orcidid><orcidid>https://orcid.org/0000-0001-5338-961X</orcidid><orcidid>https://orcid.org/0000-0003-0521-4051</orcidid><orcidid>https://orcid.org/0000-0002-6839-7134</orcidid><orcidid>https://orcid.org/0000-0001-5285-5922</orcidid><orcidid>https://orcid.org/0000-0003-3890-3849</orcidid><orcidid>https://orcid.org/0000-0002-9177-2289</orcidid><orcidid>https://orcid.org/0000-0003-0511-8422</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Brain Infarction Brief Communication Cohort Studies covert brain infarction Female Humans Ischemic Attack, Transient - complications Ischemic Attack, Transient - diagnosis Ischemic Attack, Transient - epidemiology Ischemic Stroke Leukoaraiosis Magnetic Resonance Imaging Male Prospective Studies Risk Factors Stroke - complications Stroke - diagnosis Stroke - epidemiology stroke mimic transient ischemic attack White Matter - diagnostic imaging White Matter - pathology white matter hyperintensities |
| title | Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic |
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