Clinical Predictors of Acute Ischemia in Patients with Low-Risk Neurological Deficits

Area of Science:

• Neurology
• Radiology
• Clinical Diagnostics

Background:

• Diagnosis of acute ischemia often relies on magnetic resonance imaging (MRI), a resource-limited diagnostic tool.
• Accurate diagnosis of transient ischemic attack (TIA) and minor stroke is crucial for appropriate patient management.
• Evaluating clinical variables for predicting acute infarcts in low-risk neurological events is an ongoing challenge.

Purpose of the Study:

• To determine associations between clinical variables and acute infarcts on MRI in patients with suspected low-risk TIA and minor stroke.
• To assess the predictive ability of a clinical model for identifying acute cerebral ischemia.
• To evaluate the necessity of MRI in diagnosing cerebral ischemia for low-risk neurological events.

Main Methods:

• Post-hoc analysis of the prospective, multicenter Diagnosis of Uncertain-Origin Benign Transient Neurological Symptoms (DOUBT) study.
• Logistic regression analysis was used to associate clinical characteristics with diffusion-weighted imaging (DWI)-positive lesions on MRI.
• Model performance was evaluated using Harrel's c-statistic.

Main Results:

• In 1028 patients, age, motor or speech symptoms, and absence of previous identical events were positively associated with MRI-DWI-positivity.
• Female sex, dizziness, gait instability, normal examination findings, and resolved symptoms were negatively associated with MRI-DWI-positivity.
• The predictive model demonstrated moderate discriminative ability (c-statistic 0.72).

Conclusions:

• Detailed clinical information can assist in assessing ischemia risk in low-risk neurological events.
• Despite clinical insights, a predictive model showed only moderate ability to differentiate between ischemic and non-ischemic events.
• Magnetic resonance imaging (MRI) remains necessary for confirming cerebral ischemia in patients with clinically suspected low-risk TIA or minor stroke.