Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic.

Epstein, Alessandra; Schilter, Marina; Vynckier, Jan; Kaesmacher, Johannes; Mujanovic, Adnan; Scutelnic, Adrian; Beyeler, Morin; Belachew, Nebiyat Filate; Grunder, Lorenz; Arnold, Marcel; Seiffge, David Julian; Jung, Simon; Fischer, Urs; Meinel, Thomas Raphael (2022). Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic. Journal of the American Heart Association, 11(3), e024191. American Heart Association 10.1161/JAHA.121.024191

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Background This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemic stroke. Methods and Results Single-center cohort study including consecutive patients with TIA, stroke mimics, and acute ischemic stroke, with available magnetic resonance imaging from January 2015 to December 2017. Blinded raters adjudicated WMH (age-related white matter changes score) and CBI according to established definitions. A total of 2112 patients (median [Q1-Q3] age 71 [59-80] years, 43% women, National Institutes of Health Stroke Scale score of 2 [1-7], 80% ischemic stroke, 18% TIA, 2% stroke mimics) were included. While CBIs were present in only 10% of patients with stroke mimic, they were detected in 28% of TIAs and 38% of ischemic strokes (P<0.001). WMHs were less pronounced (0, 0-1) in patients with stroke mimic, but there was no difference between TIA (1, 1-2) and ischemic stroke (0, 1-2) patients. CBIs (adjusted odds ratio, 0.3; 95% CI, 0.1-0.9) were associated with a lower rate of stroke mimic as the final diagnosis, while WMHs were not (adjusted odds ratio per point, 1.3; 95% CI, 0.7-2.2). WMH (β per point, 0.4; 95% CI, 0.3-0.6) and presence of CBI (β, 0.6; 95% CI, 0.3-0.9) were associated with a higher cardiovascular risk profile according to the ABCD3-I score. The accuracy of prediction was good for high-risk TIA (cross-validated area under the receiver operating characteristic curve, 0.89; 95% CI, 0.79-0.93) on the basis of brain imaging, age, and sex. Conclusions CBI and WMH differ between patients with stroke mimic and patients with TIA/ischemic stroke and are closely associated with established recurrence risk scores. Prospective studies need to clarify whether including brain frailty markers may contribute to the refinement of current management algorithms and risk stratifications.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Vynckier, Jan Luc; Kaesmacher, Johannes; Mujanovic, Adnan; Scutelnic, Adrian; Beyeler, Morin; Belachew, Nebiyat Filate; Grunder, Lorenz Nicolas; Arnold, Marcel; Seiffge, David Julian; Jung, Simon; Fischer, Urs and Meinel, Thomas Raphael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2047-9980

Publisher:

American Heart Association

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

07 Feb 2022 09:47

Last Modified:

07 Feb 2022 09:47

Publisher DOI:

10.1161/JAHA.121.024191

PubMed ID:

35043677

Uncontrolled Keywords:

covert brain infarction ischemic stroke stroke mimic transient ischemic attack white matter hyperintensities

BORIS DOI:

10.48350/164635

URI:

https://boris.unibe.ch/id/eprint/164635

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