Abstract
Background: Early differentiation between transient ischemic attack (TIA) and minor ischemic stroke (MIS) impacts on the patient's individual diagnostic work-up and treatment. Furthermore, estimations regarding persisting impairments after MIS are essential to guide rehabilitation programs. This study evaluated a combined clinical- and serum biomarker-based approach for the differentiation between TIA and MIS as well as the mid-term prognostication of the functional outcome, which is applicable within the first 24 h after symptom onset.Methods: Prospectively collected data were used for a retrospective analysis including the neurological deficit at admission (National Institutes of Health Stroke Scale, NIHSS) and the following serum biomarkers covering different pathophysiological aspects of stroke: Coagulation (fibrinogen, antithrombin), inflammation (C reactive protein), neuronal damage in the cellular [neuron specific enolase], and the extracellular compartment [matrix metalloproteinase-9, hyaluronic acid]. Further, cerebral magnetic resonance imaging was performed at baseline and day 7, while functional outcome was evaluated with the modified Rankin Scale (mRS) after 3, 6, and 12 months.Results: Based on data from 96 patients (age 64 ± 14 years), 23 TIA patients (NIHSS 0.6 ± 1.1) were compared with 73 MIS patients (NIHSS 2.4 ± 2.0). In a binary logistic regression analysis, the combination of NIHSS and serum biomarkers differentiated MIS from TIA with a sensitivity of 91.8% and a specificity of 60.9% [area under the curve (AUC) 0.84]. In patients with NIHSS 0 at admission, this panel resulted in a still acceptable sensitivity of 81.3% (specificity 71.4%, AUC 0.69) for the differentiation between MIS (n = 16) and TIA (n = 14). By adding age, remarkable sensitivities of 98.4, 100, and 98.2% for the prediction of an excellent outcome (mRS 0 or 1) were achieved with respect to time points investigated within the 1-year follow-up. However, the specificity was moderate and decreased over time (83.3, 70, 58.3%; AUC 0.96, 0.92, 0.91).Conclusion: This pilot study provides evidence that the NIHSS combined with selected serum biomarkers covering pathophysiological aspects of stroke may represent a useful tool to differentiate between MIS and TIA within 24 h after symptom onset. Further, this approach may accurately predict the mid-term outcome in minor stroke patients, which might help to allocate rehabilitative resources.
Highlights
Time-sensitive diagnosis of ischemic stroke is essential for patients to allow decision making regarding acute treatment, and to guide the individual diagnostic workup [1]
Considering different pathophysiological aspects of stroke, this study aimed to evaluate a combined clinical- and serum biomarker-based approach within the first 24 h after symptom onset for the differentiation between transient ischemic attack (TIA) and minor ischemic stroke (MIS) and for the prognostication of the functional outcome in MIS patients in a follow-up period of 12 months
Detailed baseline demographic and clinical data of patients are shown in Table 1 and, with the exception of a higher NIHSS and a higher mRS at admission for patients with MIS, were almost similar between patients with MIS and patients with TIA
Summary
Time-sensitive diagnosis of ischemic stroke is essential for patients to allow decision making regarding acute treatment, and to guide the individual diagnostic workup [1]. In patients presenting with minor or shortlasting neurological deficits, the differentiation between minor ischemic stroke (MIS) [2] and transient ischemic attack (TIA) is rather challenging. Knowledge on the individual diagnoses is essential to initiate rehabilitative programs early after the event with the intention to reduce stroke-related sequelae as best as possible. According to the widely applied definitions, cerebral magnetic resonance imaging (MRI) is mandatory in these patients to detect neuronal damage in terms of an ischemic lesion [3]. Differentiation between transient ischemic attack (TIA) and minor ischemic stroke (MIS) impacts on the patient’s individual diagnostic work-up and treatment. This study evaluated a combined clinical- and serum biomarker-based approach for the differentiation between TIA and MIS as well as the mid-term prognostication of the functional outcome, which is applicable within the first 24 h after symptom onset
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