Diffusion-Weighted MRI in 300 Patients Presenting Late With Subacute Transient Ischemic Attack or Minor Stroke

• Published in: Stroke (1970) 2004-11, Vol.35 (11), p.2459-2465
• Main Authors: Schulz, Ursula G., Briley, Dennis, Meagher, Tom, Molyneux, Andrew, Rothwell, Peter M.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain - pathology; Diffusion Magnetic Resonance Imaging; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Ischemic Attack, Transient - diagnosis; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Pharmacology. Drug treatments; Prospective Studies; Stroke - diagnosis; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000143455.55877.b9

Background and Purpose— Many patients with transient ischemic attack (TIA) or minor stroke present to medical attention after a delay of several days or weeks, at which time it may be more difficult to obtain a clear history and clinical signs may have resolved. Because ischemic lesions on diffusion-weighted MRI (DWI) often persist for several weeks, we hypothesized that adding DWI to a standard protocol with T2-weighted imaging might be useful in the management of patients presenting late.Methods— We studied consecutive patients with TIA or minor stroke presenting ≥3 days after the event. Two independent observers recorded the presence or absence of recent ischemic lesions on 2 different occasions, first with the T2 scan only, and second with T2 and DWI. Each time, with the aid of a written clinical summary, the observers recorded their diagnosis and proposed management.Results— 300 patients (159 men) were scanned at a median of 17 (interquartile range=10 to 23) days after symptom onset. DWI showed a high signal lesion in 114/164 (70%) minor strokes versus 17/136 (13%) TIAs (P