There have been no prospective studies on the clinical features, etiologies, and outcome of transient ischemic attack (TIA) in Korea. The aim of this study was to identify variables that can discriminate TIA from TIA mimics. Also we evaluated the characteristic of TIA patients according to the presence of diffusion-weighted imaging (DWI) lesion.
Patients were categorized into TIA and TIA mimics according to the result of an initial workup. TIA patients were divided according to the presence of DWI lesions. Baseline demographics, risk factors, laboratory results, initial blood pressure, imaging findings, recurrence rate of TIA or stroke at 3 months, and initial neurologic manifestations were prospectively collected and compared.
We evaluated a total of 252 patients (212 with TIA and 40 with TIA mimics). Steno-occlusion of the relevant artery (odds ratio [OR], 22.39; 95% confidence interval [CI], 2.03-246.73) and cardioembolic risk (OR, 32.15; 95% CI, 1.12-922.97) were significantly associated with TIA. Amnesia (OR, .001; 95% CI, .00-.05) and consciousness disturbance (OR, .003; 95% CI, .00-.06) favored TIA mimics. Perfusion defect (OR, 5.56; 95% CI, 2.90-10.68) and cardioembolic risk (OR, 2.68; 95% CI, 1.14-6.32) were significantly associated with DWI lesion. Recurrence did not significantly differ according to the presence of a lesion on DWI (positive, 4.9%; negative, 7.8%; P = .41).
Steno-occlusive disease and cardioembolic risk were independently associated with TIA. Perfusion defect and cardioembolic risk predicted positive DWI lesion. The value of various imaging modalities for predicting TIA etiology needs further evaluation.
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- Short-term prognosis after emergency department diagnosis of TIA.JAMA. 2000; 284: 2901-2906
- Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: the NORTHSTAR Study.J Neurol Neurosurg Psychiatr. 2008; 79: 38-43
- A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack.Lancet. 2005; 366: 29-36
- The high risk of stroke immediately after transient ischemic attack: a population-based study.Neurology. 2004; 62: 2015-2020
- Very early risk of stroke after a first transient ischemic attack.Stroke. 2003; 34: e138-e140
- Prediction of ischemic stroke in patients with tissue-defined transient ischemic attack.J Stroke Cerebrovasc Dis. 2014; 23: 1368-1373
- Clinical features and functional outcome of stroke after transient ischemic attack.J Stroke Cerebrovasc Dis. 2013; 22: 260-266
- Higher ABCD2 score predicts patients most likely to have true transient ischemic attack.Stroke. 2008; 39: 3096-3098
- ABCD2 scores and prediction of noncerebrovascular diagnoses in an outpatient population: a case-control study.Stroke. 2009; 40: 749-753
- Transient ischemic attack versus transient ischemic attack mimics: frequency, clinical characteristics and outcome.Cerebrovasc Dis. 2011; 32: 57-64
- Detection of diffusion-weighted MRI abnormalities in patients with transient ischemic attack: correlation with clinical characteristics.Stroke. 2003; 34: 932-937
- Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack.Stroke. 2007; 38: 1482-1488
- Assessment of transient ischemic attack with diffusion- and perfusion-weighted imaging.AJNR Am J Neuroradiol. 2004; 25: 1645-1652
- Perfusion MRI abnormalities in speech or motor transient ischemic attack patients.Stroke. 2005; 36: 2487-2489
- Patterns and predictors of early risk of recurrence after transient ischemic attack with respect to etiologic subtypes.Stroke. 2007; 38: 3225-3229
- DWI lesions and TIA etiology improve the prediction of stroke after TIA.Stroke. 2009; 40: 187-192
- The incidence and clinical predictors of acute infarction in patients with transient ischemic attack using MRI including DWI.Neuroradiology. 2013; 55: 157-163
- Prevalence of stroke and transient ischemic attack in Korean elders: findings from the Korean Longitudinal Study on Health and Aging (KLoSHA).Stroke. 2009; 40: 966-969
- The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study.BMC Neurol. 2009; 9: 58
- Clinical practice. Transient ischemic attack.N Engl J Med. 2002; 347: 1687-1692
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.Stroke. 1993; 24: 35-41
- Symptomatic steno-occlusion in patients with acute cerebral infarction: prevalence, distribution, and functional outcome.J Stroke. 2014; 16: 36-43
- MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging.AJR Am J Roentgenol. 1987; 149: 351-356
- Sequence-specific MR imaging findings that are useful in dating ischemic stroke.Radiographics. 2012; 32 (discussion 97–9): 1285-1297
- Evolution of apparent diffusion coefficient, diffusion-weighted, and T2-weighted signal intensity of acute stroke.AJNR Am J Neuroradiol. 2001; 22: 637-644
- Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry.Int J Stroke. 2014; 9: 514-518
- Assessment and management of transient ischaemic attack–the role of the TIA clinic.Ir J Med Sci. 2006; 175: 24-27
- An expansion of Simons' integrated hypothesis of trigger point formation.Curr Pain Headache Rep. 2004; 8: 468-475
- Etiologic classification of TIA and minor stroke by A-S-C-O and causative classification system as compared to TOAST reduces the proportion of patients categorized as cause undetermined.Cerebrovasc Dis. 2014; 38: 121-126
- Diffusion MRI in patients with transient ischemic attacks.Stroke. 1999; 30: 1174-1180
- Diffusion MR imaging and transient ischemic attacks.Stroke. 1999; 30: 2762-2763
- Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study.Neurology. 2011; 77: 1222-1228
- CT/CT angiography and MRI findings predict recurrent stroke after transient ischemic attack and minor stroke: results of the prospective CATCH study.Stroke. 2012; 43: 1013-1017
- Incidence and predictors of ischemic stroke events during hospitalization in patients with transient ischemic attack.Cerebrovasc Dis. 2014; 37: 330-335
- Diffusion-weighted imaging-negative patients with transient ischemic attack are at risk of recurrent transient events.Stroke. 2007; 38: 2367-2369
- Acute perfusion and diffusion abnormalities predict early new MRI lesions 1 week after minor stroke and transient ischemic attack.Stroke. 2011; 42: 2191-2195
- Factors associated with a high risk of recurrence in patients with transient ischemic attack or minor stroke.Stroke. 2008; 39: 1717-1721
Published online: June 29, 2015
Accepted: April 3, 2015
Received in revised form: April 1, 2015
Received: November 27, 2014
The authors declare that they have no conflicts of interest.
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.