Charlotte Zerna1, Jayesh Modi1, Lisa Bilston1, Ashkan Shoamanesh1, Shelagh B Coutts1, Eric E Smith2. 1. From the Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada (C.Z., L.B., S.B.C., E.E.S.); Medanta - The Medicity Hospital, Gurgaon, India (J.M.); and Division of Neurology, Department of Medicine, McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.). 2. From the Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada (C.Z., L.B., S.B.C., E.E.S.); Medanta - The Medicity Hospital, Gurgaon, India (J.M.); and Division of Neurology, Department of Medicine, McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada (A.S.). eesmith@ucalgary.ca.
Abstract
BACKGROUND AND PURPOSE: Transient focal neurological episodes occur in cerebral amyloid angiopathy (CAA) and can mimic transient ischemic attack (TIA). Risk factors and outcomes of minor ischemic stroke or TIA might differ in patients with and without cerebral microbleeds (CMBs), including CAA-consistent lobar CMB. METHODS: Baseline magnetic resonance imaging (MRI) was analyzed for CMBs and cortical superficial siderosis in 416 patients in the prospective computed tomography and MRI in the CATCH study (Triage of TIA and Minor Cerebrovascular Events to Identify High Risk Patients). Clinical symptoms, baseline characteristics, recurrence, and 90-day modified Rankin Scale were prospectively collected. MRI white-matter hyperintensity was measured using the Fazekas scale. RESULTS: CMBs were detected in 65 (15.6%) and cortical superficial siderosis in 11 patients (2.6%). Lobar CMBs were present in 49 (11.8%). In multivariable logistic regression adjusted for risk factors and age, subcortical Fazekas score was associated with lobar CMB (odds ratio, 2.07; 95% confidence interval, 1.23-3.48; P=0.006). Forty-two patients (10.1%) had lobar-only CMBs with or without cortical superficial siderosis consistent with modified Boston criteria for possible/probable CAA. The possible/probable CAA pattern was not predictive of recurrent TIA (odds ratio, 0.42; 95% confidence interval, 0.05-3.31; P=0.41), stroke (odds ratio, 1.24; 95% confidence interval, 0.26-5.99; P=0.79), or 90-day modified Rankin Scale score ≥2 (odds ratio, 1.38; 95% confidence interval, 0.62-3.07; P=0.42). CONCLUSIONS: CMBs in TIA and minor stroke are moderately common but do not predict recurrence or 90-day outcome. CAA-related transient focal neurological episodes and TIA have overlapping clinical symptoms, suggesting that MRI may be needed for differentiation.
BACKGROUND AND PURPOSE: Transient focal neurological episodes occur in cerebral amyloid angiopathy (CAA) and can mimic transient ischemic attack (TIA). Risk factors and outcomes of minor ischemic stroke or TIA might differ in patients with and without cerebral microbleeds (CMBs), including CAA-consistent lobar CMB. METHODS: Baseline magnetic resonance imaging (MRI) was analyzed for CMBs and cortical superficial siderosis in 416 patients in the prospective computed tomography and MRI in the CATCH study (Triage of TIA and Minor Cerebrovascular Events to Identify High Risk Patients). Clinical symptoms, baseline characteristics, recurrence, and 90-day modified Rankin Scale were prospectively collected. MRI white-matter hyperintensity was measured using the Fazekas scale. RESULTS:CMBs were detected in 65 (15.6%) and cortical superficial siderosis in 11 patients (2.6%). Lobar CMBs were present in 49 (11.8%). In multivariable logistic regression adjusted for risk factors and age, subcortical Fazekas score was associated with lobar CMB (odds ratio, 2.07; 95% confidence interval, 1.23-3.48; P=0.006). Forty-two patients (10.1%) had lobar-only CMBs with or without cortical superficial siderosis consistent with modified Boston criteria for possible/probable CAA. The possible/probable CAA pattern was not predictive of recurrent TIA (odds ratio, 0.42; 95% confidence interval, 0.05-3.31; P=0.41), stroke (odds ratio, 1.24; 95% confidence interval, 0.26-5.99; P=0.79), or 90-day modified Rankin Scale score ≥2 (odds ratio, 1.38; 95% confidence interval, 0.62-3.07; P=0.42). CONCLUSIONS:CMBs in TIA and minor stroke are moderately common but do not predict recurrence or 90-day outcome. CAA-related transient focal neurological episodes and TIA have overlapping clinical symptoms, suggesting that MRI may be needed for differentiation.
Authors: Hoda Gad; Adnan Khan; Naveed Akhtar; Saadat Kamran; Ahmed El-Sotouhy; Soha R Dargham; Ioannis N Petropoulos; Georgios Ponirakis; Ashfaq Shuaib; Leopold J Streletz; Rayaz A Malik Journal: PLoS One Date: 2019-03-15 Impact factor: 3.240
Authors: Duncan Wilson; Gareth Ambler; Keon-Joo Lee; Jae-Sung Lim; Masayuki Shiozawa; Masatoshi Koga; Linxin Li; Caroline Lovelock; Hugues Chabriat; Michael Hennerici; Yuen Kwun Wong; Henry Ka Fung Mak; Luis Prats-Sánchez; Alejandro Martínez-Domeño; Shigeru Inamura; Kazuhisa Yoshifuji; Ethem Murat Arsava; Solveig Horstmann; Jan Purrucker; Bonnie Yin Ka Lam; Adrian Wong; Young Dae Kim; Tae-Jin Song; Maarten Schrooten; Robin Lemmens; Sebastian Eppinger; Thomas Gattringer; Ender Uysal; Zeynep Tanriverdi; Natan M Bornstein; Einor Ben Assayag; Hen Hallevi; Jun Tanaka; Hideo Hara; Shelagh B Coutts; Lisa Hert; Alexandros Polymeris; David J Seiffge; Philippe Lyrer; Ale Algra; Jaap Kappelle; Rustam Al-Shahi Salman; Hans R Jäger; Gregory Y H Lip; Heinrich P Mattle; Leonidas D Panos; Jean-Louis Mas; Laurence Legrand; Christopher Karayiannis; Thanh Phan; Sarah Gunkel; Nicolas Christ; Jill Abrigo; Thomas Leung; Winnie Chu; Francesca Chappell; Stephen Makin; Derek Hayden; David J Williams; M Eline Kooi; Dianne H K van Dam-Nolen; Carmen Barbato; Simone Browning; Kim Wiegertjes; Anil M Tuladhar; Noortje Maaijwee; Christine Guevarra; Chathuri Yatawara; Anne-Marie Mendyk; Christine Delmaire; Sebastian Köhler; Robert van Oostenbrugge; Ying Zhou; Chao Xu; Saima Hilal; Bibek Gyanwali; Christopher Chen; Min Lou; Julie Staals; Régis Bordet; Nagaendran Kandiah; Frank-Erik de Leeuw; Robert Simister; Aad van der Lugt; Peter J Kelly; Joanna M Wardlaw; Yannie Soo; Felix Fluri; Velandai Srikanth; David Calvet; Simon Jung; Vincent I H Kwa; Stefan T Engelter; Nils Peters; Eric E Smith; Yusuke Yakushiji; Dilek Necioglu Orken; Franz Fazekas; Vincent Thijs; Ji Hoe Heo; Vincent Mok; Roland Veltkamp; Hakan Ay; Toshio Imaizumi; Beatriz Gomez-Anson; Kui Kai Lau; Eric Jouvent; Peter M Rothwell; Kazunori Toyoda; Hee-Joon Bae; Joan Marti-Fabregas; David J Werring Journal: Lancet Neurol Date: 2019-05-23 Impact factor: 59.935
Authors: Joel Elliot Dane Stanton; Arvind Chandratheva; Duncan Wilson; Isabel Charlotte Hostettler; Saiful Islam; David John Werring Journal: J Neurol Date: 2019-10-03 Impact factor: 4.849