Abstract TMP98: Transient Ischemic Attack in Children and Its Relationship to Cerebral Infarction Identified by MRI

Abstract

Objectives: Recent definition of transient ischemic attack (TIA) in adults includes negative neuroimaging for ischemic injury. Among children, TIA has not been well characterized. Further, the extent to which TIA symptoms are associated with MRI evidence of new cerebral injury has not been investigated. We present a cohort of 68 children with TIA symptoms and associated neuroimaging (MRI). Methods: We searched the patient medical record database at Boston Children’s Hospital using the search terms “transient ischemic attack” or “TIA” in the year 2010. We examined cases of TIAs in children 18 years of age or younger whose TIA occurred between 2009 to 2011. TIA was defined as a focal neurologic deficit that resolved completely. We only included children who had an MRI done close to the time of the event. A blinded neuroradiologist evaluated all MRIs. Results: Diffusion weighted imaging was done in 82% of cases in the cohort. Time from TIA to MRI varied from the day of TIA to 122 days after TIA with 68% scanned within 10 days of TIA presentation. Following TIA, nine of the 68 patients (13%) sustained a stroke verified by evidence of new ischemic injury in a vascular territory on neuroimaging. Time from initial TIA to stroke occurrence varied from hours to 3 years. Acute stroke was documented within one week of TIA in 56% of children who developed stroke following TIA. Further, 67% of the children who had a stroke after TIA demonstrated neuroimaging evidence of arteriopathy as compared to only 10% of children who did not have a stroke. Recurrent TIA was more common in children who eventually had a stroke (78%) than in children who did not have a stroke (59%). Conclusion: In our cohort of 68 children who presented with TIA symptoms, 13% subsequently demonstrated evidence of acute cerebral infarction by neuroimaging, some as early as the first week following TIA. Like adults, TIA symptoms may herald stroke in children. Clinical evidence of cerebral arteriopathy and multiple TIAs may identify children at high risk for stroke after presentation with TIA symptoms. Additional inquiry to identify features of TIAs in children that impart high risk for stroke and their treatment is warranted.