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Sun J, Sui Y, Chen Y, Lian J, Wang W. Predicting acute ischemic stroke using the revised Framingham stroke risk profile and multimodal magnetic resonance imaging. Front Neurol 2023; 14:1264791. [PMID: 37840926 PMCID: PMC10568328 DOI: 10.3389/fneur.2023.1264791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Background and purpose Patients with transient ischemic attacks (TIA) have a significant risk of developing acute ischemic strokes (AIS), emphasizing the critical need for hierarchical management. This study aims to develop a clinical-imaging model utilizing multimodal magnetic resonance imaging (mMRI) and the revised Framingham Stroke Risk Profile (FSRP) to predict AIS and achieve early secondary prevention. Methods mMRI scans were conducted on patients with symptomatic intracranial atherosclerotic disease (ICAD) to assess vascular wall features and cerebral perfusion parameters. Based on diffusion-weighted imaging (DWI), patients were divided into two groups: TIA and AIS. Clinical data were evaluated to calculate the FSRP score. Differences in clinical and imaging characteristics between the groups were analyzed, and a predictive model for AIS probability in patients with ICAD was established. Results A total of 112 TIA and AIS patients were included in the study. The results showed that the AIS group had higher proportions of FSRP-high risk, hyperhomocysteinemia, and higher value of low-density lipoprotein (LDL), standardized plaque index (SQI), and enhancement rate (ER) compared to the TIA group (p < 0.05). Mean transit time (MTT) and time to peak (TTP) in the lesion area were significantly longer in the AIS group (p < 0.05). Multivariate analysis identified FSRP-high risk (p = 0.027) and high ER (p = 0.046) as independent risk factors for AIS. The combined clinical and mMRI model produced an area under the curve (AUC) of 0.791 in receiver operating characteristic (ROC) analysis. The constructed nomogram model combining clinical and mMRI features demonstrated favorable clinical net benefits. Conclusion FSRP-high risk and high ER were confirmed as independent risk factors for AIS. The combined prediction model utilizing clinical and imaging markers effectively predicts stroke risk in symptomatic ICAD patients.
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Affiliation(s)
- Jiali Sun
- Department of MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Sui
- Department of MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue Chen
- Department of MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianxiu Lian
- Department of Advisory Clinical Scientist C&TS North, Philips Healthcare, Beijing, China
| | - Wei Wang
- Department of MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
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Poupore N, Strat D, Mackey T, Brown K, Snell A, Nathaniel TI. Thrombolytic therapy in ischemic stroke patients with a preceding transient ischemic attack in telestroke and non‐telestroke settings. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/ncn3.12426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Nicolas Poupore
- University of South Carolina School of Medicine Greenville Greenville SC USA
| | - Dan Strat
- University of South Carolina School of Medicine Greenville Greenville SC USA
| | - Tristan Mackey
- University of South Carolina School of Medicine Greenville Greenville SC USA
| | - Katherine Brown
- University of South Carolina School of Medicine Greenville Greenville SC USA
| | - Ashley Snell
- University of South Carolina School of Medicine Greenville Greenville SC USA
| | - Thomas I. Nathaniel
- University of South Carolina School of Medicine Greenville Greenville SC USA
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Lodha N, Harrell J, Eisenschenk S, Christou EA. Motor Impairments in Transient Ischemic Attack Increase the Odds of a Subsequent Stroke: A Meta-Analysis. Front Neurol 2017. [PMID: 28638365 PMCID: PMC5461338 DOI: 10.3389/fneur.2017.00243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background and purpose Transient ischemic attack (TIA) increases the risk for a subsequent stroke. Typical symptoms include motor weakness, gait disturbance, and loss of coordination. The association between the presence of motor impairments during a TIA and the chances of a subsequent stroke has not been examined. In the current meta-analysis, we examine whether the odds of a stroke are greater in TIA individuals who experience motor impairments as compared with those who do not experience motor impairments. Methods We conducted a systematic search of electronic databases as well as manual searches of the reference lists of retrieved articles. The meta-analysis included studies that reported an odds ratio relating motor impairments to a subsequent stroke, or the number of individuals with or without motor impairments who experienced a subsequent stroke. We examined these studies using rigorous meta-analysis techniques including random effects model, forest and funnel plots, I2, publication bias, and fail-safe analysis. Results Twenty-four studies with 15,129 participants from North America, Australia, Asia, and Europe qualified for inclusion. An odds ratio of 2.11 (95% CI, 1.67–2.65, p = 0.000) suggested that the chances of a subsequent stroke are increased by twofolds in individuals who experience motor impairments during a TIA compared with those individuals who have no motor impairments. Conclusion The presence of motor impairments during TIA is a significantly high-risk clinical characteristic for a subsequent stroke. The current evidence for motor impairments following TIA relies exclusively on the clinical reports of unilateral motor weakness. A comprehensive examination of motor impairments in TIA will enhance TIA prognosis and restoration of residual motor impairments.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Jane Harrell
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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Tarola G, Phillips RB. Chiropractic Response to a Spontaneous Vertebral Artery Dissection. J Chiropr Med 2015; 14:183-90. [PMID: 26778932 DOI: 10.1016/j.jcm.2015.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes. CLINICAL FEATURES A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient's pain in the most severe category. INTERVENTION AND OUTCOME The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately. CONCLUSION Recognition and rapid response by the chiropractic physician provided the optimum outcome for this particular patient.
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Affiliation(s)
- Gary Tarola
- Private Practice, Lehigh Valley Medical Network, Allentown, PA
| | - Reed B Phillips
- Adjunct Faculty, Southern California University of Health Sciences, Whittier, CA
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Hospital-Based Prospective Registration of Acute Transient Ischemic Attack and Noncerebrovascular Events in Korea. J Stroke Cerebrovasc Dis 2015; 24:1803-10. [PMID: 26139456 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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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Li Q, Zhu X, Feng C, Fang M, Liu X. Duration of symptom and ABCD2 score as predictors of risk of early recurrent events after transient ischemic attack: a hospital-based case series study. Med Sci Monit 2015; 21:262-7. [PMID: 25604068 PMCID: PMC4310715 DOI: 10.12659/msm.892525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to refine clinical risk factor stratification and make an optimal intervention plan to prevent ischemic stroke. MATERIAL/METHODS Clinical data, including diffusion-weighted imaging (DWI) findings, were collected in a cohort of hospitalized transient ischemic attack (TIA) patients from January 2010 to December 2011. Recurrent cerebrovascular events after TIA, including recurrent TIA, minor stroke, and major stroke, were identified by face-to-face follow-up. A multivariate, ordinal, logistic regression model was used to determine significant predictors of recurrent events. RESULTS Of 106 TIA patients, 24 (22.6%) had recurrent TIA and 20 (18.9%) had a stroke within 7 days. Hypertension, dyslipidemia, a history of ischemic stroke or TIA, and ABCD2 score were significantly associated with the recurrent events after TIA (P<0.001, P=0.02, P<0.001, P=0.02). Hypertension (RR=9.21; 95% CI, 3.07-27.61, P<0.001) and duration of symptom (RR=1.10; 95% CI, 1.02-1.17, P=0.01) as an item of ABCD2 score were highly predictive of the severity of recurrent events, whereas ABCD2 score as a whole (P=0.18) proved to be less strongly predictive. CONCLUSIONS A history of hypertension and long duration of symptom independently and significantly predict severe recurrent events after TIA within 7 days, but a high ABCD2 score was less strongly predictive of severe recurrent events.
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Affiliation(s)
- Qiang Li
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Xiaolong Zhu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Chao Feng
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Min Fang
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China (mainland)
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Hayashi T, Sehara Y, Kato Y, Fukuoka T, Deguchi I, Ohe Y, Maruyama H, Horiuchi Y, Sano H, Nagamine Y, Tanahashi N. Clinical characteristics of cardioembolic transient ischemic attack: comparison with noncardioembolic transient ischemic attack. J Stroke Cerebrovasc Dis 2014; 23:2169-2173. [PMID: 25088173 DOI: 10.1016/j.jstrokecerebrovasdis.2014.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Previous studies show that 6%-31% of transient ischemic attacks (TIA) were caused by cardiogenic cerebral embolism (cardioembolic TIA). As prompt initiation of therapy is essential in TIA to prevent subsequent strokes, determining their cause is important. In this study, we aim to determine the features of cardioembolic TIA and to compare them with those of noncardioembolic etiology. METHODS We retrospectively reviewed patients with a tissue-defined TIA who were admitted to our hospital from April 2007 to August 2013. The etiology was categorized according to Trial of Org 10172 in Acute Stroke Treatment, and TIA of cardioembolic origin and cervicocerebrovascular etiology (noncardioembolic TIA) were included in this study. Those with 2 or more possible causes or undetermined etiologies were excluded. Age, sex, comorbidities, ABCD2 score, and CHADS2 score were assessed and compared between the 2 groups. RESULTS There were no significant differences in the neurologic symptoms and their duration, morbidities of hypertension, diabetes, and dyslipidemia between the 2 groups. Coronary and peripheral artery diseases were more common in the cardioembolic TIA group (18.4% vs. 6.9%). Incidences of prior stroke and cerebral infarction determined by MRI were similar between the 2 groups. The ABCD2 score showed a similar distribution, but the CHADS2 score was significantly different; the cardioembolic TIA group showed a higher score (P = .005). CONCLUSIONS Clinical features are similar in tissue-defined TIA of cardioembolic and noncardioembolic etiologies. The CHADS2 score can be useful in assessing the probability of cardioembolic TIA.
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Affiliation(s)
- Takeshi Hayashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan.
| | - Yoshihide Sehara
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Yuji Kato
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Takuya Fukuoka
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Ichiro Deguchi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Yasuko Ohe
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Hajime Maruyama
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Yohsuke Horiuchi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Hiroyasu Sano
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Yuito Nagamine
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Norio Tanahashi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University, International Medical Center, Hidaka, Japan
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