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Multicenter Study
. 2023 Feb 7;12(3):e027861.
doi: 10.1161/JAHA.122.027861. Epub 2023 Jan 25.

Association Between Duration of Transient Neurological Events and Diffusion-Weighted Brain Lesions

Raed A Joundi  1 , Amy Y X Yu  2 , Eric E Smith  3 , Charlotte Zerna  4 , Andrew M Penn  5 , Robert F Balshaw  6 , Kristine Votova  7 , Maximilian B Bibok  8 , Melanie Penn  5 , Viera Saly  5 , Janka Hegedus  5 , Shelagh B Coutts  3 ; SpecTRA Study Group [Link]
Collaborators, Affiliations
Multicenter Study

Association Between Duration of Transient Neurological Events and Diffusion-Weighted Brain Lesions

Raed A Joundi et al. J Am Heart Assoc. .

Abstract

Background The relationship between duration of transient neurological events and presence of diffusion-weighted lesions by symptom type is unclear. Methods and Results This was a substudy of SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment), a multicenter prospective cohort of patients with minor ischemic cerebrovascular events or stroke mimics at academic emergency departments in Canada. For this study we included patients with resolved symptoms and determined the presence of diffusion-weighted imaging (DWI) lesion on magnetic resonance imaging within 7 days. Using logistic regression, we evaluated the association between symptom duration and DWI lesion, assessing for interaction with symptom type (focal only versus nonfocal/mixed), and adjusting for age, sex, education, comorbidities, and systolic blood pressure. Of 658 patients included, a DWI lesion was present in 232 (35.1%). There was a significant interaction between symptom duration and symptom type. For those with focal-only symptoms, there was a continuous increase in DWI probability up to 24 hours in duration (ranging from ≈40% to 80% probability). In stratified analyses, the increase in probability of DWI lesion with increased duration of focal symptoms was seen in women but not men. For those with nonfocal or mixed symptoms, predicted probability of DWI lesion was ≈35% and was greater in men, but did not increase with longer duration. Conclusions Increased duration of neurological deficits is associated with greater probability of DWI lesion in those with focal symptoms only. For individuals with nonfocal or mixed symptoms, about one-third had DWI lesions, but the probability did not increase with duration. These results may be important to improve risk stratification of transient neurological events.

Keywords: diffusion‐weighted imaging; focal symptoms; magnetic resonance imaging; minor stroke; symptom duration; transient ischemic attack.

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Figures

Figure 1
Figure 1. Study flowchart.
MRI indicates magnetic resonance imaging.
Figure 2
Figure 2. Predicted probability of DWI lesion as a function of event duration and symptom type among those with self‐reported symptom resolution.
Results are shown for the main analysis (A), with all 3 symptom categories (B), among men only (C), and women only (D). DWI indicates diffusion‐weighted imaging.
Figure 3
Figure 3. Predicted probability of DWI lesion as a function of event duration and symptom type among those with no new deficits on clinical examination (A) and those with both self‐reported symptom resolution in addition to no new deficits on examination (B).
DWI indicates diffusion‐weighted imaging.
See this image and copyright information in PMC

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