Muhammad Nagy1, Muhammad U Azeem1, Youssef Soliman1, Sahil A Nawab2, Adalia H Jun-O'Connell1, Richard P Goddeau1, Majaz Moonis1, Brian Silver1, Nils Henninger3. 1. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts. 2. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Biochemistry, Worcester Polytechnic Institute, Worcester, Massachusetts. 3. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: nils.henninger@umassmed.edu.
Abstract
GOALS: There are no validated biomarkers that allow for reliable distinction between TIA and other transient neurological symptoms that mimic TIA. We sought to determine whether the degree of pre-existing white matter hyperintensity (WMH) lesion burden relates to the diagnostic certainty of TIA in a cohort of patients presenting with transient neurological symptoms. MATERIALS AND METHODS: We retrospectively analyzed 144 consecutive patients with available brain MRI to quantify and normalize the WMH volume for brain atrophy (adjusted white matter hyperintensity [aWMHV]). We first stratified subjects to probable (n = 62) versus possible (n = 82) TIA as per existing guidelines. Receiver-operating characteristic curves were used to determine a critical aWMHV-threshold (7.8 mL) that best differentiated probable from possible TIA. We then further stratified patients with possible TIA to likely (n = 52) versus unlikely (n = 30) TIA after independent chart review and adjudication. Finally, multivariable logistic and multinomial regression was used to determine whether the defined aWMHV independently related to probable and likely TIA after adjustment for pertinent confounders. FINDINGS: With the exception of age (P < .001) and use of antiplatelets (P = .017), baseline characteristics were similar between patients with probable, likely, and unlikely TIA. In the fully adjusted multinomial model, the aWMHV cut-off greater than 7.8 mL (odds ratio 3.8, 95% confidence interval 1.3-10.9, P = .012) was significantly more frequent in patients with a probable TIA as compared to those with an unlikely TIA diagnosis. CONCLUSIONS: We provide proof-of-principle that WMH may serve as a neuroimaging marker of diagnostic certainty of TIA after neurological workup has been completed.
GOALS: There are no validated biomarkers that allow for reliable distinction between TIA and other transient neurological symptoms that mimic TIA. We sought to determine whether the degree of pre-existing white matter hyperintensity (WMH) lesion burden relates to the diagnostic certainty of TIA in a cohort of patients presenting with transient neurological symptoms. MATERIALS AND METHODS: We retrospectively analyzed 144 consecutive patients with available brain MRI to quantify and normalize the WMH volume for brain atrophy (adjusted white matter hyperintensity [aWMHV]). We first stratified subjects to probable (n = 62) versus possible (n = 82) TIA as per existing guidelines. Receiver-operating characteristic curves were used to determine a critical aWMHV-threshold (7.8 mL) that best differentiated probable from possible TIA. We then further stratified patients with possible TIA to likely (n = 52) versus unlikely (n = 30) TIA after independent chart review and adjudication. Finally, multivariable logistic and multinomial regression was used to determine whether the defined aWMHV independently related to probable and likely TIA after adjustment for pertinent confounders. FINDINGS: With the exception of age (P < .001) and use of antiplatelets (P = .017), baseline characteristics were similar between patients with probable, likely, and unlikely TIA. In the fully adjusted multinomial model, the aWMHV cut-off greater than 7.8 mL (odds ratio 3.8, 95% confidence interval 1.3-10.9, P = .012) was significantly more frequent in patients with a probable TIA as compared to those with an unlikely TIA diagnosis. CONCLUSIONS: We provide proof-of-principle that WMH may serve as a neuroimaging marker of diagnostic certainty of TIA after neurological workup has been completed.
Authors: M E Gurol; M C Irizarry; E E Smith; S Raju; R Diaz-Arrastia; T Bottiglieri; J Rosand; J H Growdon; S M Greenberg Journal: Neurology Date: 2006-01-10 Impact factor: 9.910
Authors: Alan J Gow; Mark E Bastin; Susana Muñoz Maniega; Maria C Valdés Hernández; Zoe Morris; Catherine Murray; Natalie A Royle; John M Starr; Ian J Deary; Joanna M Wardlaw Journal: Neurology Date: 2012-10-23 Impact factor: 9.910
Authors: J Donald Easton; Jeffrey L Saver; Gregory W Albers; Mark J Alberts; Seemant Chaturvedi; Edward Feldmann; Thomas S Hatsukami; Randall T Higashida; S Claiborne Johnston; Chelsea S Kidwell; Helmi L Lutsep; Elaine Miller; Ralph L Sacco Journal: Stroke Date: 2009-05-07 Impact factor: 7.914
Authors: Linshu Wang; Kiran Chaudhari; Ali Winters; Yuanhong Sun; Raymond Berry; Christina Tang; Shao-Hua Yang; Ran Liu Journal: Transl Stroke Res Date: 2022-07-22 Impact factor: 6.800