Six-Month Outcome of Transient Ischemic Attack and Its Mimics

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.

Adherence to anticoagulant guideline for atrial fibrillation: A large care gap among stroke patients in a rural population

“…Finally, setting up an anticoagulation clinic would be a place where attention can be focused on providing precise and timely treatment to AF patients. Similar clinics have been seen in previous studies of AF, [24] as well as for management of other medical conditions, such as TIA [25][26][27]. Further research should be done to determine an appropriate model that will increase the efficiency and efficacy of AF patients' treatment.…”

Clinical Risk Score for Predicting Recurrence Following a Cerebral Ischemic Event

“…ABCD 2 score has been widely replicated and studied in different cohorts with conflicting results. While many studies (15, 16, 33, 35, 37, 40–53) have validated ABCD 2 with c-statistics/area under the ROC curve ranging from 0.57 to 0.88 (not all of these studies provided c-statistics/AUC), there were a few studies which have raised doubts about the predictive value of ABCD 2 (54–67). In particular, high rates of recurrence was observed in low-risk groups in studies with large sample size (54, 56, 57).…”

Ischemic stroke with a preceding Trans ischemic attack (TIA) less than 24 hours and thrombolytic therapy

“…The presence of a focal lesion on Diffusion-weighted magnetic resonance imaging (DW-MRI) is an important factor in the classification of TIA [12][13][14][15], and represents a contraindication for rtPA therapy [16]. The new tissue-based description of a TIA as a transient episode of neurological dysfunction without acute infarction is not a contraindication for rtPA in TIA-ischemic stroke patients [17].…”