Prevalence of Positive Diffusion-Weighted Imaging Findings and Ischemic Stroke Recurrence in Transient Ischemic Attack

Gon, Yasufumi; Sakaguchi, Manabu; Okazaki, Shuhei; Mochizuki, Hideki; Kitagawa, Kazuo

doi:10.1016/j.jstrokecerebrovasdis.2014.12.023

Cited by 14 publications

(21 citation statements)

References 20 publications

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“…33,34 D-Dimer measurement in transient ischemic attack (TIA) predicts DWI-positive TIA but did not predict stroke recurrence. 35 However, some recent studies reported that high D-dimer levels at admission were predictive of the recurrent stroke in cryptogenic stroke patients. Kim et al 36 showed elevated D-dimer levels (>1.0 mg/ml) at admission significantly increased the risk of recurrent stroke with 9.7% of annual stroke rate (1.8% in D-dimer levels 1.0 mg/ml) in cryptogenic stroke and were an independent predictor for recurrent ischemic stroke especially in cryptogenic stroke with patent foramen ovale (PFO).…”

Section: Cryptogenic Stroke/embolic Stroke Of Undetermined Source Etimentioning

confidence: 99%

The emerging value of serum D-dimer measurement in the work-up and management of ischemic stroke

Ohara

Farhoudi

Bang

et al. 2019

International Journal of Stroke

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Background Elevated D-dimer levels are a marker of both thrombin formation and fibrinolysis. Currently D-dimer measurement is routinely used for ruling out venous thromboembolism and diagnosis/monitoring of disseminated intravascular coagulation. Recent emerging data suggest that D-dimer may become an important biomarker in ischemic stroke as well as in cardiovascular diseases. Aims To outline the clinical utility of D-dimer in work-up and management of ischemic stroke. Summary D-dimer measurement is most useful in stroke with active cancer as it can confirm etiologic diagnosis, predict recurrent stroke risk, and aid treatment decision in cancer-associated stroke. In cryptogenic stroke, high D-dimer levels can also provide clues for the cause of stroke as occult cancer and undetected cardiac embolic source as occult atrial fibrillation and may be helpful in treatment decision making of secondary stroke prevention. Serial D-dimer measurements should be further studied to monitor antithrombotic therapy effectiveness in both cardiogenic and cryptogenic etiologies. Conclusion Accumulating data suggests the utility of D-dimer test in the management of ischemic stroke, although the evidence is still limited. Future studies would clarify the role of D-dimer measurement in ischemic stroke.

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Section: Cryptogenic Stroke/embolic Stroke Of Undetermined Source Etimentioning

confidence: 99%

The emerging value of serum D-dimer measurement in the work-up and management of ischemic stroke

Ohara

Farhoudi

Bang

et al. 2019

International Journal of Stroke

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“…MRI has played an important role in the evaluation of stroke severity and recovery, as well as in the selection of therapy regimens (6, 7). Several different kinds of functional MRI techniques have been used in stroke, for example, diffusion-weighted imaging (DWI) (8–10), perfusion-weighted imaging (PWI) (11), and MR angiography (12). Amide proton transfer (APT) MR imaging (13, 14), a type of chemical exchange saturation transfer (CEST) imaging (15), has shown promise in the detection of a separate pH-based acidosis penumbra in animal stroke models (16–18), even before a diffusion abnormality.…”

Section: Introductionmentioning

confidence: 99%

Amide Proton Transfer MRI Signal as a Surrogate Biomarker of Ischemic Stroke Recovery in Patients With Supportive Treatment

Chen

et al. 2019

Front. Neurol.

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Background: Amide proton transfer (APT) MR imaging has shown great potential in the evaluation of stroke severity because of its sensitivity to acid environments. However, this promising MRI technique has not been used to assess treatment efficacy with regard to stroke recovery. Purpose: To assess the therapeutic effect of supportive treatment in ischemic stroke patients using the pH-sensitive APT MRI technique. Material and Methods: Forty-three ischemic stroke patients at an early stage were recruited and scanned with conventional and APT MRI sequences at 3T before treatment. After treatment, 26 patients underwent a follow-up MRI scan (one to three times on different days). The magnetization-transfer-ratio asymmetry at 3.5 ppm, usually called the APT-weighted (APTW) signal, was measured. The APTW signal changes following treatment were analyzed. Results: Baseline APTW signal intensities in the infarcted lesions inversely correlated with baseline stroke severity. Lesion APTW values gradually increased with time in 24 cases (92.3%) with a follow-up MRI scan, showing clinical symptom improvements. Two cases (7.7%) showed further decreased APTW signal in the follow-up scan, accompanied by clinical symptom aggravation. Compared to the baseline, significant APTW signal increases were found for all post-treatment patients (efficacious), whether based on post-treatment or on stroke onset times. The increase in APTW signal in the ischemic stroke lesion after treatment was associated with an improvement in clinical symptoms. Conclusion: The APTW signal would be a useful imaging biomarker by which to assess the therapeutic efficacy of ischemic stroke treatment.

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“…The sensitivity analysis revealed that the odds of a subsequent stroke did not alter considerably with the exclusion of individual studies. Further, when studies with highest risk of bias (quality scores < 14) (18, 26, 27, 35, 37, 38) were excluded the overall odds ratio improved to 2.12 (95% CI, 1.58–2.84; p = 0.000).…”

Section: Resultsmentioning

confidence: 99%

“…This procedure involved entering the odds ratios, lower and upper limits, and confidence levels relating motor weakness to subsequent stroke from each study and then determining an overall odds ratio (Figure 2). For those studies that did not report an odds ratio (18–21, 23, 24, 26, 27, 29–31, 36–41), we computed the odd ratios as OR = ( A / B )/( C / D ). Here, A is the number of individuals with weakness and a recurrent stroke, B is the number of individuals with weakness without a recurrent stroke, C is the number of individuals without weakness with a recurrent stroke, and D is the number of individuals without weakness and without a recurrent stroke.…”

Section: Methodsmentioning

confidence: 99%

Motor Impairments in Transient Ischemic Attack Increase the Odds of a Subsequent Stroke: A Meta-Analysis

et al. 2017

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Background and purposeTransient ischemic attack (TIA) increases the risk for a subsequent stroke. Typical symptoms include motor weakness, gait disturbance, and loss of coordination. The association between the presence of motor impairments during a TIA and the chances of a subsequent stroke has not been examined. In the current meta-analysis, we examine whether the odds of a stroke are greater in TIA individuals who experience motor impairments as compared with those who do not experience motor impairments.MethodsWe conducted a systematic search of electronic databases as well as manual searches of the reference lists of retrieved articles. The meta-analysis included studies that reported an odds ratio relating motor impairments to a subsequent stroke, or the number of individuals with or without motor impairments who experienced a subsequent stroke. We examined these studies using rigorous meta-analysis techniques including random effects model, forest and funnel plots, I2, publication bias, and fail-safe analysis.ResultsTwenty-four studies with 15,129 participants from North America, Australia, Asia, and Europe qualified for inclusion. An odds ratio of 2.11 (95% CI, 1.67–2.65, p = 0.000) suggested that the chances of a subsequent stroke are increased by twofolds in individuals who experience motor impairments during a TIA compared with those individuals who have no motor impairments.ConclusionThe presence of motor impairments during TIA is a significantly high-risk clinical characteristic for a subsequent stroke. The current evidence for motor impairments following TIA relies exclusively on the clinical reports of unilateral motor weakness. A comprehensive examination of motor impairments in TIA will enhance TIA prognosis and restoration of residual motor impairments.

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Prevalence of Positive Diffusion-Weighted Imaging Findings and Ischemic Stroke Recurrence in Transient Ischemic Attack

Cited by 14 publications

References 20 publications

The emerging value of serum D-dimer measurement in the work-up and management of ischemic stroke

The emerging value of serum D-dimer measurement in the work-up and management of ischemic stroke

Amide Proton Transfer MRI Signal as a Surrogate Biomarker of Ischemic Stroke Recovery in Patients With Supportive Treatment

Motor Impairments in Transient Ischemic Attack Increase the Odds of a Subsequent Stroke: A Meta-Analysis

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