Cerebrovascular events - from transient ischemic attack and transient global amnesia to transient ischemic attack with MRI-DWI lesions.

Aim of study: To compare transient ischemic attack (TIA), transient global amnesia (TGA), and transient ischemic attack with lesions found in magnetic resonance imaging/diffusion-weighted imaging (MRI-DWI) scans, in order to find similarities and differences in their clinical picture.

Clinical rationale for study: Magnetic resonance imaging scans account for a substantial part of the financial burden associa-ted with cerebrovascular events. Finding initial clinical features that differentiate transient brain ischemic events will be useful in developing standardized procedures for selecting patients who require further radiological imaging, thereby reducing overall costs.

Material and methods: A total of 9701 patients hospitalized in two major tertiary hospitals in the Silesian voivodeship in Poland between January 2016 and July 2024 with a diagnosis of TGA, TIA, and ischemic stroke were analyzed. The final group consisted of 947 patients, who were further divided into three categories: 425 TIA (44.87%), 125 TGA (13.19%), and 387 TIA with MRI-DWI lesions (41.92%). The data of patients were statistically analyzed.

Results: Patients with transient focal symptoms and confirmed DWI lesions in MRI scans were significantly older. They were more likely to have coronary heart disease, had higher C-reactive protein (CRP) levels, more severe symptoms, and were less likely to receive antiplatelet treatment than TGA and TIA patients. Transient global amnesia patients had higher systolic blood pressure on admission compared to other groups.

Conclusions: The presence of DWI-MRI lesions is associated with a higher initial clinical burden. Our results confirm that the lack of stroke prevention therapies may have determined the more severe course of the vascular event. This study supports a sudden rise in blood pressure being a contributing factor in TGA patients.

Clinical implications: Older patients with TIAs, having several vascular risk factors, but lacking prevention therapies are likely to present with cerebral lesions on DWI-MRI. These patients should undergo additional imaging procedures.