FLAIR vascular hyperintensities predict early ischemic recurrence in transient ischemic attack

Abstract

Though lesion negative transient ischemic attack (TIA) patients accounted for considerable amounts in clinical fields, their diagnoses are interrupted with many mimic diseases (e.g., seizure, migraine, hypoglycemia, psychotic disease). To assess more objective diagnosis of true ischemic origin TIA patients, we evaluated the relationship between FLAIR vascular hyperintensity (FVH) and early ischemic lesion recurrence [FU-DWI (+)] in lesion negative transient ischemic attack (TIA) patients.

We recruited consecutive lesion negative TIA patients within 24 hours of symptom onset, who underwent follow-up MRI during the acute period. FVH was defined as a focal or serpentine high signal intensity on FLAIR images. Furthermore, to compare clinical outcomes between the FU-DWI (+) and FU-DWI (-) groups, we assessed 1-year recurrent ischemic stroke or TIA.

Among 392 lesion negative TIA patients, 82 patients had FU-DWI (+) on the follow-up MRI. In the multivariate analysis, FVH remained an independent predictor of FU-DWI (+) [adjusted OR (aOR) = 4.77, 95% confidence interval (CI) 2.45-9.29, P < 0.001]. The time to initial MRI (aOR = 0.49, 95% CI = 0.33-0.70, P < 0.001) and intracranial atherosclerosis (aOR = 2.07, 95% CI = 1.10-3.92, P = 0.025) were also associated with FU-DWI (+), independent of FVH. In clinical outcomes, the FU-DWI (+) group showed more frequent 1-year recurrent ischemic stroke events than the FU-DWI (-) group (10.7% versus 3.1%, respectively, P = 0.007).

FVH is associated with FU-DWI (+) in lesion negative TIA patients. As FU-DWI (+) commonly occurs during the acute period and has a subsequent worse outcome after discharge, additional radiological or clinical markers for it are necessary.