Patrick C Gallogly, Jasmine Hassan, Caitlin Lee, John Cousins, Jonathan Best, H Rolf Jäger, Davis J Werring, Arvind Chandratheva
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We identified clinical factors predicting DWI positivity using multivariable logistic regression.</p><p><strong>Results: </strong>We included 1615 patients. Of 442 (27.4%) who were DWI-positive, 38.5% had atypical presentations; common symptoms included headache (present in 17%), unsteadiness (15%), positive sensory symptoms (11%), presyncope (10%), confusion (9%), and vertigo (8%). Symptoms independently associated with DWI positivity included weakness (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.01-1.67), dysarthria (OR: 2.05, CI: 1.56-2.70), and ataxia (OR: 3.76, CI: 2.27-6.21). Fluctuating symptoms (present in 21.5%) predicted DWI positivity (OR: 1.37, CI: 1.04-1.81), but sudden onset (80.1%) did not (OR: 1.05, CI: 0.80-1.38). Risk factors associated with DWI positivity included increasing age (OR: 1.02/year, CI: 1.01-1.02), hypertension (OR: 1.61, CI: 1.23-2.11), diabetes (OR: 1.40, CI: 1.04-1.90), and smoking (OR: 1.67, CI: 1.17-2.37). DWI-positive patients had significantly more risk factors (mean 2.65 vs 1.95 p = <0.001).</p><p><strong>Conclusion: </strong>Over one-third of people with MRI-DWI-confirmed TIA or minor stroke present with atypical symptoms. MRI-DWI is essential to diagnose cerebral ischaemia in patients with atypical symptoms, particularly in those with vascular risk factors.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251368895"},"PeriodicalIF":8.7000,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical features, including atypical symptoms, associated with acute cerebral ischaemia on DWI-MRI in suspected TIA and minor stroke.\",\"authors\":\"Patrick C Gallogly, Jasmine Hassan, Caitlin Lee, John Cousins, Jonathan Best, H Rolf Jäger, Davis J Werring, Arvind Chandratheva\",\"doi\":\"10.1177/17474930251368895\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>The diagnosis of transient ischaemic attack (TIA) and minor stroke can be challenging. Current diagnostic criteria for TIA disqualify atypical clinical presentations which may nevertheless be associated with objective cerebral ischaemia on diffusion weighted imaging-magnetic resonance imaging (DWI-MRI). We aimed to (1) ascertain the proportion of DWI-positive patients with atypical clinical presentations and (2) identify clinical factors predicting DWI positivity.</p><p><strong>Methods: </strong>We retrospectively reviewed case notes of consecutive patients with suspected TIA or minor stroke undergoing MRI at our comprehensive stroke center. We identified clinical factors predicting DWI positivity using multivariable logistic regression.</p><p><strong>Results: </strong>We included 1615 patients. Of 442 (27.4%) who were DWI-positive, 38.5% had atypical presentations; common symptoms included headache (present in 17%), unsteadiness (15%), positive sensory symptoms (11%), presyncope (10%), confusion (9%), and vertigo (8%). Symptoms independently associated with DWI positivity included weakness (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.01-1.67), dysarthria (OR: 2.05, CI: 1.56-2.70), and ataxia (OR: 3.76, CI: 2.27-6.21). Fluctuating symptoms (present in 21.5%) predicted DWI positivity (OR: 1.37, CI: 1.04-1.81), but sudden onset (80.1%) did not (OR: 1.05, CI: 0.80-1.38). Risk factors associated with DWI positivity included increasing age (OR: 1.02/year, CI: 1.01-1.02), hypertension (OR: 1.61, CI: 1.23-2.11), diabetes (OR: 1.40, CI: 1.04-1.90), and smoking (OR: 1.67, CI: 1.17-2.37). DWI-positive patients had significantly more risk factors (mean 2.65 vs 1.95 p = <0.001).</p><p><strong>Conclusion: </strong>Over one-third of people with MRI-DWI-confirmed TIA or minor stroke present with atypical symptoms. 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引用次数: 0
摘要
背景与目的短暂性脑缺血发作（TIA）和轻微脑卒中的诊断具有挑战性。目前TIA的诊断标准不符合非典型临床表现，但在DWI-MRI上可能与客观脑缺血有关。我们的目的是：(1)确定临床表现不典型的dwi阳性患者的比例；(2)确定预测DWI阳性的临床因素。方法回顾性分析在综合卒中中心连续接受MRI检查的疑似TIA或轻微卒中患者的病例记录。我们使用多变量逻辑回归确定预测DWI阳性的临床因素。结果纳入1615例患者。在442例（27.4%）dwi阳性患者中，38.5%有不典型表现；常见症状包括头痛（17%）、身体不稳（15%）、感觉阳性症状（11%）、晕厥前期（10%）、精神错乱（9%）和眩晕（8%）。与dwi阳性独立相关的症状包括虚弱（OR 1.30 95% CI 1.01-1.67）、构音障碍（OR 2.05 CI 1.56-2.70）和共济失调（OR 3.76 CI 2.27-6.21）。波动症状（21.5%）预测DWI阳性（OR 1.37 CI 1.04-1.81），但突然发作（80.1%）不预测DWI阳性（OR 1.05, CI 0.80-1.38）。与DWI阳性相关的危险因素包括年龄增加（OR 1.02/年CI 1.01-1.02）、高血压（OR 1.61 CI 1.23-2.11）、糖尿病（OR 1.40 CI 1.04-1.90）和吸烟（OR 1.67 CI 1.17-2.37）。dwi阳性患者的危险因素明显更多(平均2.65 vs 1.95 p=
Clinical features, including atypical symptoms, associated with acute cerebral ischaemia on DWI-MRI in suspected TIA and minor stroke.
Background and aims: The diagnosis of transient ischaemic attack (TIA) and minor stroke can be challenging. Current diagnostic criteria for TIA disqualify atypical clinical presentations which may nevertheless be associated with objective cerebral ischaemia on diffusion weighted imaging-magnetic resonance imaging (DWI-MRI). We aimed to (1) ascertain the proportion of DWI-positive patients with atypical clinical presentations and (2) identify clinical factors predicting DWI positivity.
Methods: We retrospectively reviewed case notes of consecutive patients with suspected TIA or minor stroke undergoing MRI at our comprehensive stroke center. We identified clinical factors predicting DWI positivity using multivariable logistic regression.
Results: We included 1615 patients. Of 442 (27.4%) who were DWI-positive, 38.5% had atypical presentations; common symptoms included headache (present in 17%), unsteadiness (15%), positive sensory symptoms (11%), presyncope (10%), confusion (9%), and vertigo (8%). Symptoms independently associated with DWI positivity included weakness (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.01-1.67), dysarthria (OR: 2.05, CI: 1.56-2.70), and ataxia (OR: 3.76, CI: 2.27-6.21). Fluctuating symptoms (present in 21.5%) predicted DWI positivity (OR: 1.37, CI: 1.04-1.81), but sudden onset (80.1%) did not (OR: 1.05, CI: 0.80-1.38). Risk factors associated with DWI positivity included increasing age (OR: 1.02/year, CI: 1.01-1.02), hypertension (OR: 1.61, CI: 1.23-2.11), diabetes (OR: 1.40, CI: 1.04-1.90), and smoking (OR: 1.67, CI: 1.17-2.37). DWI-positive patients had significantly more risk factors (mean 2.65 vs 1.95 p = <0.001).
Conclusion: Over one-third of people with MRI-DWI-confirmed TIA or minor stroke present with atypical symptoms. MRI-DWI is essential to diagnose cerebral ischaemia in patients with atypical symptoms, particularly in those with vascular risk factors.
期刊介绍：
The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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