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Transient ischemic attack with infarction: A unique syndrome?

Authors

  • Hakan Ay MD,

    Corresponding author
    1. Department of A. A. Martinos Center for Biomedical Imaging and Stroke Service, Department of Radiology, Boston, MA
    2. Department of Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
    • A. A. Martinos Center for Biomedical Imaging and Stroke Service, Departments of Neurology and Radiology, Massachusetts General Hospital, CNY149-2301, Charlestown, MA 02129
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  • Walter J. Koroshetz MD,

    1. Department of Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • Thomas Benner PhD,

    1. Department of A. A. Martinos Center for Biomedical Imaging and Stroke Service, Department of Radiology, Boston, MA
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  • Mark G. Vangel PhD,

    1. Department of A. A. Martinos Center for Biomedical Imaging and Stroke Service, Department of Radiology, Boston, MA
    2. Department of GCRC Biomedical Imaging Core, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • Ona Wu PhD,

    1. Department of A. A. Martinos Center for Biomedical Imaging and Stroke Service, Department of Radiology, Boston, MA
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  • Lee H. Schwamm MD,

    1. Department of Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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  • A. Gregory Sorensen MD

    1. Department of A. A. Martinos Center for Biomedical Imaging and Stroke Service, Department of Radiology, Boston, MA
    2. Department of Division of Health Sciences and Technology, Harvard–Massachusetts Institute of Technology, Boston, MA
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Abstract

It is debated whether transient symptoms associated with infarction (TSI) are best considered a minor ischemic stroke, a subtype of transient ischemic attack (TIA), or a separate ischemic brain syndrome. We studied clinical and imaging features to establish similarities and differences among ischemic stroke, TIA without infarction, and TSI. Eighty-seven consecutive patients with TIA and 74 patients with ischemic stroke were studied. All underwent diffusion-weighted imaging on admission. Symptom duration and infarct volume were determined in each group. Thirty-six patients (41.3%) with TIA had acute infarct(s). Although TIA-related infarcts were smaller than those associated with ischemic stroke (mean, 0.7 vs 27.3ml; p < 0.001), there was no lesion size threshold that distinguished ischemic stroke from TSI. In contrast, the symptom duration probability density curve was not broad, but instead peaked early with only a few patients having symptoms for longer than 200 minutes. The probability density function for symptom duration was similar between TIA with or without infarction. The in-hospital recurrent ischemic stroke and TIA rate was 19.4% in patients with TSI and 1.3% in those with ischemic stroke. TIA with infarction appears to have unique features separate from TIA without infarction and ischemic stroke. We propose identifying TSI as a separate clinical syndrome with distinct prognostic features. Ann Neurol 2005;57:679–686

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