Assessing Acute DWI Lesions in Clinically Diagnosed TIA: Insights from a Cohort Study in Cluj, Romania

TL;DR

This study found that nearly 27% of patients diagnosed with TIA had brain lesions on MRI, reclassifying them as minor strokes, emphasizing the need for early imaging.

Contribution

The study provides real-world data on the prevalence of DWI lesions in clinically diagnosed TIA cases under the updated definition.

Findings

26.9% of TIA patients had ischemic lesions on DWI, reclassifying them as minor strokes.

Comorbidities like hypertension and diabetes were associated with higher lesion prevalence.

Early MRI-DWI improves TIA diagnosis and risk stratification when combined with the ABCD2 score.

Abstract

Background: The updated definition of a TIA emphasizes tissue characteristics rather than symptom duration, defining a TIA as a transient neurological episode without ischemic lesions in brain imaging, including in DWI. If imaging reveals a lesion, even in patients with transient symptoms, the event is reclassified as a minor ischemic stroke. Objective: This retrospective observational study aimed to determine the prevalence of ischemic lesions in DWI in patients with a TIA diagnosis. Results: Adults aged 18–90 years, diagnosed with a TIA by a neurologist and who underwent MRI-DWI at CMT hospital within the first week after symptom onset (May 2023–July 2024), were included. Ethical approval was obtained. Descriptive statistics summarized patient demographics, clinical features, Fazekas scale grades, and imaging findings. Conclusions: Among the 26 patients clinically diagnosed with TIAs, 7 (26.9%) exhibited ischemic lesions in DWI, reclassifying these cases as minor ischemic strokes under the updated definition. The prevalence of ischemic lesions was notably higher in patients with comorbidities such as hypertension and diabetes. These findings highlight the importance of early MRI-DWI to accurately distinguish TIAs from minor ischemic strokes. Routine urgent DWI within the first week of TIA symptoms enhances diagnosis and risk stratification and can guide targeted stroke prevention strategies, particularly when combined with the ABCD2 score.

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