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Do transient ischemic attacks with diffusion-weighted imaging abnormalities correspond to brain infarctions?

C Oppenheim1, C Lamy, E Touzé

  • 1Department of Neuroradiology, Université Paris Descartes, Centre Hospitalier Sainte-Anne, Paris, France. c.oppenheim@ch-sainte-anne.fr

AJNR. American Journal of Neuroradiology
|September 15, 2006
PubMed
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Most diffusion-weighted imaging (DWI) changes in transient ischemic attack (TIA) patients indicate permanent injury, similar to stroke. This suggests TIA cases with neuroimaging abnormalities should be diagnosed as stroke.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Transient ischemic attack (TIA) is a temporary stroke symptom.
  • Diffusion-weighted imaging (DWI) detects acute ischemic changes.
  • The reversibility of DWI changes in TIA is not fully understood.

Purpose of the Study:

  • To determine if DWI abnormalities in TIA resolve or indicate permanent tissue damage.
  • To compare imaging features of reversible versus irreversible TIA lesions.

Main Methods:

  • 103 TIA patients were evaluated with initial DWI.
  • 33 patients with DWI abnormalities underwent follow-up MRI (including DWI, FLAIR, T2, T1-weighted sequences) after 10.6 months.
  • Quantitative DWI parameters (volume, ADC ratio) were analyzed for reversible and irreversible lesions.

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Main Results:

  • 79% of patients with initial DWI abnormalities showed subsequent infarct on follow-up MRI.
  • 76.3% of initial DWI lesions were associated with permanent injury.
  • Larger DWI lesion volume and lower ADC ratio on initial DWI predicted permanent injury.

Conclusions:

  • Most DWI-positive TIAs result in permanent injury, mirroring stroke outcomes.
  • Findings support redefining TIA to include stroke diagnosis for transient deficits with neuroimaging abnormalities.
  • This redefinition aligns clinical presentation with underlying pathology for TIA.