Multiple acute cerebral infarcts on diffusion-weighted imaging and risk of recurrent stroke

Wen, Hai-qi; Lam, Wynnie W. M.; Rainer, Timothy; Fan, Yu; Leung, Thomas W.; Chan, Y. L.; Wong, Ka Sing

doi:10.1212/01.wnl.0000140490.22251.b6

Cited by 74 publications

(75 citation statements)

References 11 publications

(10 reference statements)

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“…This seems intuitive and in support of this, other groups have found that multiple lesions at baseline on MRI predict recurrent clinical events. 16,21 Previous work looking at recurrent MR lesions 16 found the rate of any recurrent lesions to be higher than our study at 34%. One reason for this is that the populations of patients are different; we examined only mild stroke and TIA patients (NIHSS Ͻ 6).…”

contrasting

confidence: 53%

“…Like others we have shown that large artery disease and cardioembolic mechanisms are associated with an increased risk. 16,21 This result has implications for stroke prevention and potential impact on the evolution and understanding of vascular dementia. 25 There have been several publications on the high risk of recurrent clinical events in patients with TIA [1][2][3][4][5][6] and minor stroke; however, none of them have examined recurrent imaging events.…”

Section: Resultsmentioning

confidence: 99%

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Late subdural hygromas from birth trauma

Ney¹,

Joseph²,

Mitchell³

2005

Neurology

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Abstract-Background:In a general population of patients with stroke, the rate of new MRI lesions at 1 week was much higher than expected. With patients with minor stroke and TIA having a higher risk of recurrent clinical events, the authors examined whether patients with minor stroke and TIA also had a high rate of asymptomatic lesions on repeat MRI scanning. Methods: Patients with minor stroke and TIA presenting within 12 hours of symptom onset with a NIH Stroke Scale score less than six, who had a baseline MRI and a 1-month follow-up, were enrolled in this study. The follow-up study was examined for new diffusion-weighted imaging lesions as compared to the baseline study. Clinical or MRI factors predicting recurrent lesions were examined. Results: A total of 143 patients were enrolled and 14 patients (9.8%; 95% CI 5.4, 15.9) had MR evidence of new lesions at 30 days. Six of these new lesions were clinically asymptomatic (42.9%; 95% CI 17.7, 71.1). A trend to increased likelihood of new lesions at 30 days was seen with progressing baseline scan lesion number (none [2.2%], solitary [12.9%], multiple [19.8%]: p ϭ 0.046). Patients whose mechanism of stroke was large artery or cardioembolic were the most likely to have new lesions on follow-up MRI. Conclusion: Minor stroke and TIA are associated with a 10% risk of new lesions on MRI and half of these new lesions are asymptomatic. This risk is lower than seen in more severely affected patients with stroke. Patients with multiple lesions at baseline are at an increased risk for new ischemic lesions. NEUROLOGY 2005;65:513-517 It is known that both prior TIA and minor stroke confer a higher risk of recurrent stroke 1 with such a similar prognosis that the difference between the two is probably redundant.2,3 The short-term, 90-day, risk of stroke following a speech or motor TIA is between 10 and 20%. [4][5][6] Among patients with mild stroke, deemed too mild for thrombolytic therapy, one third are dependent or dead at hospital discharge. 7 One potential reason for some of these patients to become clinically worse is recurrent ischemia.It has been presumed that TIA was associated with complete resolution of brain ischemia leaving no permanent brain injury. 8,9 However, half of patients with TIA, according to the classic definition of complete symptom resolution within 24 hours of onset, have injury observed on diffusion-weighted imaging (DWI) of the brain on MRI.10-14 DWI is particularly sensitive to small volume lesions or multiple lesions that may be missed by brain CT. The pattern of lesion has also been used to successfully predict the mechanism of the stroke with different lesion patterns predicting causal categories defined by the TOAST classification. 15In a general population of hospital-based patients with stroke the rate of new lesions seen on MRI at 1 week was 34%. 16 Most of these events were clinically silent with only 2% having evidence of clinical recurrence. The population studied included patients who were treated with thrombolysis or had evidence of ...

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contrasting

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Late subdural hygromas from birth trauma

Ney¹,

Joseph²,

Mitchell³

2005

Neurology

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“…We collected data on previously published clinical [1][2][3][4][5][6][7][14][15][16][17][18] and imaging features 7,[19][20][21][22][23] of index stroke associated with increased risk of re- Abbreviations: CCS ϭ Causative Classification of Stroke System; CI ϭ confidence interval; HR ϭ hazard ratio; IQR ϭ interquartile range.…”

Section: Methods Patient Population the Primary Derivationmentioning

confidence: 99%

“…Multiple acute infarcts 20,21 Multiple noncontiguous lesions that were hyperintense on DWI and hypointense on ADC maps…”

Section: Imaging Feature Definitionmentioning

confidence: 99%

A score to predict early risk of recurrence after ischemic stroke

Ay¹,

Güngör²,

Arsava³

et al. 2010

Neurology

125

123

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“…4 -7 However, studies that assessed the prognostic value of positive DWI findings and TIA etiology either were underpowered or used composite outcomes that included cardiac events or recurrent TIA. [5][6][7][8][9][10] Moreover, because positive DWI findings and TIA etiology may be correlated with several components of the ABCD 2 score, 11,12 it remains uncertain whether those potential factors can predict the early risk of stroke independently of the ABCD 2 score. We therefore assessed the additional value of positive DWI findings and TIA etiology to predict the early risk of stroke in a cohort of 343 consecutive TIA patients admitted to a stroke unit.…”

mentioning

confidence: 99%

DWI Lesions and TIA Etiology Improve the Prediction of Stroke After TIA

Calvet

Touzé

Oppenheim

et al. 2009

Stroke

154

133

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Background and Purpose-The ABCD 2 score has been shown to predict the early risk of stroke after transient ischemic attack (TIA). The additional predictive value of diffusion-weighted imaging (DWI) and TIA etiology is not well known. Methods-From January 2003 to June 2007, 343 consecutive patients (meanϮSD age, 62.4Ϯ15.4 years) with TIA were admitted to our stroke unit. Most (339) patients underwent DWI and all had an etiologic work-up and were followed up for 3 months. The predictive value of the ABCD 2 score, positive DWI findings, large-artery atherosclerosis (LAA), and atrial fibrillation (AF) with respect to occurrence of ischemic stroke at 1 week and 3 months was assessed. Results-DWI was positive in 136 (40%) patients. Sixty (17%) patients had LAA and 27 (8%) had AF. Patients with positive DWI findings were more likely to have unilateral weakness (odds ratio [OR]ϭ2.2; 95% CI, 1.3 to 3.7), TIA duration Ն60 minutes (ORϭ2.6; 95% CI, 1.3 to 5.2), ABCD 2 Ͼ5 (ORϭ4.7; 95% CI, 2.0 to 11.0), LAA (ORϭ1.8; 95% CI, 1.0 to 3.1), and AF (ORϭ3.5; 95% CI, 1.5 to 8.0). During follow-up, 5 patients had a stroke within 7 days (absolute riskϭ1.5%, 95% CI, 0.3% to 2.7%), and 10 had a stroke within 3 months (absolute riskϭ2.9%; 95% CI, 1.1% to 4.7%). All early strokes but 1 occurred in patients with positive DWI findings. ABCD 2 score and positive DWI findings were associated with an increased 7-day and 3-month risk of stroke. At 3 months, ABCD 2 score Ͼ5 (hazard ratioϭ10.1; 95% CI, 1.1 to 93.4), positive DWI result (hazard ratioϭ8.7; 95% CI, 1.1 to 71.0), and LAA (hazard ratioϭ3.4; 95% CI, 1.0 to 11.8) were independently associated with an increased risk of stroke. There was no association with AF. Conclusions-Taking DWI and TIA etiology into account in addition to the ABCD 2 score improves the prediction of the early risk of stroke after TIA.

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Multiple acute cerebral infarcts on diffusion-weighted imaging and risk of recurrent stroke

Cited by 74 publications

References 11 publications

Late subdural hygromas from birth trauma

Late subdural hygromas from birth trauma

A score to predict early risk of recurrence after ischemic stroke

DWI Lesions and TIA Etiology Improve the Prediction of Stroke After TIA

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