Six-Month Outcome of Transient Ischemic Attack and Its Mimics

Alireza Sadighi,Vida Abedi,Nada El Andary,Alia Stanciu,Mihai Banciu,Ramin Zand,Neil Holland

doi:10.3389/fneur.2019.00294

Alireza Sadighi, Vida Abedi + Show 5 more

Open Access

https://doi.org/10.3389/fneur.2019.00294

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Abstract

Background and Objective: Although the risk of recurrent cerebral ischemia is higher after a transient ischemic attack (TIA), there is limited data on the outcome of TIA mimics. The goal of this study is to compare the 6-month outcome of patients with negative and positive diffusion-weighted imaging (DWI) TIAs (DWI-neg TIA vs. DWI-pos TIA) and also TIA mimics.Methods: We prospectively studied consecutive patients with an initial diagnosis of TIA in our tertiary stroke centers in a 2-year period. Every included patient had an initial magnetic resonance (MR) with DWI and one-, three-, and six-month follow-up visits. The primary outcome was defined as the composition of intracerebral hemorrhage, ischemic stroke, TIA, coronary artery disease, and death.Results: Out of 269 patients with the initial diagnosis of TIA, 259 patients (mean age 70.5 ± 15.0 [30–100] years old, 56.8% men) were included in the final analysis. Twenty-one (8.1%, 95% confidence interval [CI] 5.1-12.1%) patients had a composite outcome event within the six-month follow-up. Five (23.8%) and 13 (61.9%) composite outcome events occurred in the first 30 and 90 days, respectively. Among patients with DWI-neg TIA, the one- and six-month ischemic stroke rate was 1.5 and 4.6%, respectively. The incidence proportion of composite outcome event was significantly higher among patients who had the diagnosis of DWI-neg TIA compared with those who had the diagnosis of TIA mimics (12.2 vs. 2.1%—relative risk 5.9; 95% CI, 1.4–25.2). In our univariable analysis among patients with DWI-neg TIA and DWI-pos TIA, age (P = 0.017) was the only factor that was significantly associated with the occurrence of the composite outcome.Conclusion: Our study indicated that the overall six-month rate of the composite outcome among patients DWI-neg TIA, DWI-pos TIA, and TIA mimics were 12.2, 9.7, and 2.1%, respectively. Age was the only factor that was significantly associated with the occurrence of the composite outcome.

Highlights

After a transient ischemic attack (TIA), the risk of ischemic stroke is high and ranging from 9 to 20% within the first 3 months [1,2,3]
Patients who are classified as TIA mimics have the heterogeneous etiologies ranging from cardiac ischemic events, dementia, strokes, to benign conditions [11, 12]
The primary outcome was defined as the composition of intracerebral hemorrhage (ICH), ischemic stroke, TIA, coronary artery disease (CAD), and all-cause death

Summary

Introduction

After a transient ischemic attack (TIA), the risk of ischemic stroke is high and ranging from 9 to 20% within the first 3 months [1,2,3]. Some of the previous TIA outcome studies used the TIA clinical definition that alone cannot differentiate between a DWI-neg (DWI: diffusion-weighted imaging, neg: negative) TIA and DWI-pos (pos: positive) TIA. In this prospective study, we aimed to assess and compare the 6-month outcome of patients with DWI-neg TIA and TIA mimics, as well as patients with DWI-pos TIA. The goal of this study is to compare the 6-month outcome of patients with negative and positive diffusion-weighted imaging (DWI) TIAs (DWI-neg TIA vs DWI-pos TIA) and TIA mimics

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Conclusion