White Matter Hyperintensity Volume Influences Symptoms in Patients Presenting With Minor Neurological Deficits

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Acute minor neurological deficits are common in emergency departments.
• Differentiating transient ischemic attack/minor stroke from stroke mimics is challenging.

Purpose of the Study:

• To evaluate the utility of white matter hyperintensity (WMH) volume in diagnosing acute minor neurological deficits.
• To assess the relationship between WMH volume, diagnosis, symptoms, and stroke recurrence.

Main Methods:

• Post hoc analysis of the SpecTRA study (n=1485) including adult patients with acute minor neurological deficits.
• Measurement of WMH volume using fluid-attenuated inversion recovery imaging.
• Analysis of final diagnosis, presenting symptoms, and 90-day stroke recurrence.

Main Results:

• Mean WMH volume was significantly higher in transient ischemic attack/minor stroke patients compared to stroke mimics (P<0.001).
• WMH volume alone was not associated with the final diagnosis.
• The combination of diffusion-weighted imaging positivity and high WMH volume correlated with lower odds of focal symptoms (P=0.035).

Conclusions:

• High WMH volume combined with positive diffusion-weighted imaging is associated with fewer focal symptoms in patients with minor neurological deficits.
• WMH volume is a potentially important diagnostic consideration.
• Absence of focal symptoms should not deter further investigation for suspected cerebral ischemia.