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Keywords:

  • cerebral infarction;
  • Diffusion-weighted MRI ;
  • TIA definition;
  • transient ischemic attack

Background

Transient ischemic attack has been redefined as a tissue-based diagnosis and MRI recommended as the preferred imaging modality. We aimed to investigate whether an increased use of MRI leads to a decrease in the proportion of TIA as compared to cerebral infarction. We also sought to see whether DWI-positive patients with transient ischemic symptoms <24 h differ from DWI-negative TIA patients in terms of performed diagnostic investigations and clinical characteristics.

Methods

Patients admitted with cerebral infarction or TIA in the period 2006–2011 were prospectively registered. The use of MRI in patients with transient ischemic symptoms <24 h and proportion of TIA were annually recorded. DWI-positive and DWI-negative patients with transient ischemic symptoms <24 h were compared in univariate analyses regarding baseline data, diagnostic investigations, and etiology. Multivariate analyses were performed to identify predictors of DWI lesions.

Results

The use of MRI increased from 65.0% in 2006–2008 to 89.0% in 2009–2011 (< 0.001). The proportion of TIA as compared to cerebral infarction decreased from 12.2% in 2006–2008 to 8.3% in 2009–2011 (= 0.002). DWI-positive patients were more often examined with 24-h Holter monitoring (< 0.001) and echocardiography (< 0.001). Lower age (< 0.001) and prior myocardial infarction (< 0.029) were independently associated with DWI lesions in patients with transient ischemic symptoms <24 h.

Conclusions

An increased use of MRI and a tissue-based TIA definition resulted in a decrease in the proportion of TIA at discharge as compared to cerebral infarction. DWI-positive patients had a more extensive cardiac work-up and were associated with lower age and prior myocardial infarction.