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A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Risk prediction of subsequent early stroke in patients with transient ischemic attacks
Anastasios Chatzikonstantinou1, Marc E Wolf, Anke Schaefer
1Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
Cerebrovascular Diseases (Basel, Switzerland)
|September 14, 2013
Summary
Symptom fluctuations are a better predictor of early stroke risk after transient ischemic attacks (TIAs) than ABCD2 or ABCD3-I scores. This easily accessible sign aids in identifying high-risk patients for prompt intervention.
Area of Science:
- Neurology
- Cardiology
- Medical Diagnostics
Background:
- Transient ischemic attacks (TIAs) require accurate early stroke risk prediction.
- Clinical scores like ABCD2 and ABCD3-I, along with specific symptoms, are used to assess this risk.
- The prognostic utility of these scores and symptoms needs further comparison.
Purpose of the Study:
- To compare the predictive utility of established clinical scores (ABCD2, ABCD3-I) and symptom fluctuations for early stroke risk in hospitalized TIA patients.
- To evaluate the effectiveness of various clinical and imaging findings in predicting stroke outcomes.
Main Methods:
- A cohort of 235 TIA patients admitted to a Comprehensive Stroke Center was studied.
- Patients underwent continuous monitoring, detailed brain imaging (including DWI), vascular ultrasound, neurological scoring, and ECG monitoring over 3 days.
- Symptom fluctuation was defined as recurrent TIA symptom episodes (≥2 times within 24 hours), distinct from the ABCD3-I 'dual TIA' definition.
Main Results:
- Out of 235 patients, 17 (7.2%) experienced an early stroke during hospitalization.
- ABCD2 scores did not predict early stroke (p=0.544), while ABCD3-I scores showed a correlation (p=0.021).
- Symptom fluctuations significantly predicted early stroke (76.5% of stroke patients, p<0.001), outperforming individual DWI findings, carotid stenosis, or AF detection.
Conclusions:
- Symptom fluctuations represent a highly valuable, accessible, and applicable parameter for predicting high early stroke risk following TIAs.
- While ABCD3-I scores are useful, symptom fluctuations offer superior individual prognostic capability.
- This finding can guide clinical decision-making and patient management strategies for TIA patients.
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