3 research outputs found
Association Between Duration of Transient Neurological Events and DiffusionâWeighted Brain Lesions
Background The relationship between duration of transient neurological events and presence of diffusionâweighted 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 diffusionâweighted imaging (DWI) lesion on magnetic resonance imaging within 7âdays. 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 focalâonly symptoms, there was a continuous increase in DWI probability up to 24âhours in duration (ranging from â40% 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 â35% 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 oneâthird had DWI lesions, but the probability did not increase with duration. These results may be important to improve risk stratification of transient neurological events
Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study
Abstract
Background
Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear.
Methods
A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset <â24âh, NIHSS<â4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis.
Results
Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6âyears) and more likely to be male (58%) than stroke-mimics (61.4âyears, 41%; each pâ<â0.001). TIA/MS patients had higher SBP than stroke-mimics (pâ<â0.001). DBP did not differ between the two groups (pâ=â0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10âmmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00â1.39) in patients <â60âyears, and 23% (OR 1.23, 95% CI 11.12â1.35) in those 60â79âyears, while not affecting the odds of TIA/MS in patients â„80âyears (OR 0.99, 95% CI 0.89â1.07).
Conclusions
Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase cliniciansâ suspicion of TIA/MS.
Trial registration
ClinicalTrials.gov
NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered