Andrew Bivard1, Thomas Lillicrap2, Bénédicte Maréchal2, Carlos Garcia-Esperon2, Elizabeth Holliday2, Venkatesh Krishnamurthy2, Christopher R Levi2, Mark Parsons2. 1. From the Department of Neurology, John Hunter Hospital (A.B., T.L., C.G.-E., V.K., C.R.L., M.P.) and Hunter Medical Research Institute (A.B., T.L., C.G.-E., E.H., V.K., C.R.L., M.P.), University of Newcastle, New South Wales, Australia; Advanced Clinical Imaging Technology, Siemens Healthcare HC CEMEA SUI DI PI, Lausanne, Switzerland (B.M.); Department of Radiology, CHUV, Lausanne, Switzerland (B.M.); and LTS5, EPFL, Lausanne, Switzerland (B.M.). Andrew.bivard@newcastle.edu.au. 2. From the Department of Neurology, John Hunter Hospital (A.B., T.L., C.G.-E., V.K., C.R.L., M.P.) and Hunter Medical Research Institute (A.B., T.L., C.G.-E., E.H., V.K., C.R.L., M.P.), University of Newcastle, New South Wales, Australia; Advanced Clinical Imaging Technology, Siemens Healthcare HC CEMEA SUI DI PI, Lausanne, Switzerland (B.M.); Department of Radiology, CHUV, Lausanne, Switzerland (B.M.); and LTS5, EPFL, Lausanne, Switzerland (B.M.).
Abstract
BACKGROUND AND PURPOSE: Transient ischemic attack (TIA) initiates an ischemic cascade without resulting in frank infarction and, as such, represents a novel model to study the effects of this ischemic cascade and secondary neurodegeneration in humans. METHODS: Patients with suspected TIA underwent acute brain perfusion imaging, and those with acute ischemia were enrolled into a prospective observational study. We collected baseline and 90-day magnetic resonance imaging, including MP-RAGE (high-resolution T1 sequence) and cognitive assessment with the Montreal Cognitive Assessment. Brain morphometry and within patient statistical analysis were performed to identify changes between baseline and 90-day imaging and clinical assessments. RESULTS: Fifty patients with TIA with acute perfusion lesions were studied. All patients experienced a decrease in global cortical gray matter (P=0.005). Patients with anterior circulation TIA (n=31) also had a significant reduction in the volume of the pons (P<0.001), ipsilesional parietal lobe (P<0.001), occipital lobe (P=0.002), frontal lobe (P<0.001), temporal lobe (P=0.003), and thalamus (P=0.016). Patients with an anterior perfusion lesion on acute imaging also had a significant decrease in Montreal Cognitive Assessment between baseline and day 90 (P=0.027), which may be related to the volume of thalamic atrophy (R2=0.28; P=0.009). CONCLUSIONS: In a prospective observational study, patients with TIA confirmed by acute perfusion imaging experienced a significant reduction in global gray matter and focal structural atrophy related to the area of acute ischemia. The atrophy also resulted in a proportional decreased cognitive performance on the Montreal Cognitive Assessment. Further studies are required to identify the mechanisms of this atrophy.
BACKGROUND AND PURPOSE: Transient ischemic attack (TIA) initiates an ischemic cascade without resulting in frank infarction and, as such, represents a novel model to study the effects of this ischemic cascade and secondary neurodegeneration in humans. METHODS:Patients with suspected TIA underwent acute brain perfusion imaging, and those with acute ischemia were enrolled into a prospective observational study. We collected baseline and 90-day magnetic resonance imaging, including MP-RAGE (high-resolution T1 sequence) and cognitive assessment with the Montreal Cognitive Assessment. Brain morphometry and within patient statistical analysis were performed to identify changes between baseline and 90-day imaging and clinical assessments. RESULTS: Fifty patients with TIA with acute perfusion lesions were studied. All patients experienced a decrease in global cortical gray matter (P=0.005). Patients with anterior circulation TIA (n=31) also had a significant reduction in the volume of the pons (P<0.001), ipsilesional parietal lobe (P<0.001), occipital lobe (P=0.002), frontal lobe (P<0.001), temporal lobe (P=0.003), and thalamus (P=0.016). Patients with an anterior perfusion lesion on acute imaging also had a significant decrease in Montreal Cognitive Assessment between baseline and day 90 (P=0.027), which may be related to the volume of thalamic atrophy (R2=0.28; P=0.009). CONCLUSIONS: In a prospective observational study, patients with TIA confirmed by acute perfusion imaging experienced a significant reduction in global gray matter and focal structural atrophy related to the area of acute ischemia. The atrophy also resulted in a proportional decreased cognitive performance on the Montreal Cognitive Assessment. Further studies are required to identify the mechanisms of this atrophy.
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