Prevalence and Associations of MRI-Demonstrated Brain Infarcts in Elderly Subjects With a History of Transient Ischemic Attack

Bhadelia, Rafeeque A.; Anderson, Mary R.; Polak, Joseph F.; Manolio, Teri A.; Beauchamp, Norman J.; Knepper, Laurie; O’Leary, Daniel H.

doi:10.1161/01.str.30.2.383

Cited by 29 publications

(12 citation statements)

References 56 publications

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“…Across various studies, MRI has shown at least 1 infarct somewhere in the cerebrum in 46% to 81% of TIA patients. 121,122 In the past decade, new MRI techniques of diffusion and perfusion imaging have afforded new insights into the pathophysiology of cerebral ischemia. The spectrum of ischemic tissue alterations underlying transient clinical symptoms is now understood to variably include synaptic transmission failure, cytotoxic edema, and permanent tissue injury, and these processes are easily delineated in individual patients on MRI.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…Across various studies, MRI has shown at least 1 infarct somewhere in the cerebrum in 46% to 81% of TIA patients. 121,122 In the past decade, new MRI techniques of diffusion and perfusion imaging have afforded new insights into the pathophysiology of cerebral ischemia. 29 -32,34 -38,40 -44,123-127 These series show convergent results regarding the frequency of DWI positivity among TIA patients; among the 19 studies including 1117 patients, the aggregate rate of DWI positivity is 39%, with frequency by site ranging from 25% to 67%.…”

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confidence: 99%

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Definition and Evaluation of Transient Ischemic Attack

Easton

Saver²,

Albers³

et al. 2009

Stroke

1,592

563

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Abstract-Thishours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD 2 score Ն3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis. Key Words: AHA Scientific Statements Ⅲ brain Ⅲ brain ischemia Ⅲ cerebral ischemia Ⅲ ischemia Ⅲ stroke Ⅲ transient ischemic attack Ⅲ acute stroke syndromes Ⅲ acute cerebrovascular syndromes R ecent scientific studies have revised our understanding of 3 key aspects of transient ischemic attack (TIA): how it is best defined, what the early risk of stroke and other vascular outcomes is, and how it is best evaluated. This statement reviews and synthesizes recent scientific advances regarding the definition, urgency, and evaluation of TIA and is designed to aid the clinician in the short-and long-term management of patients with TIA. DefinitionTIAs are brief episodes of neurological dysfunction resulting from focal cerebral ischemia not associated withThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on January 16, 2009. A copy of the statement is available at http://www.americanheart.org/presenter.jhtml?identifierϭ3003999 by selecting either the "topic list" link or the "chronological list" link (No. LS-2037). To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifierϭ3023366.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml?identifierϭ4431. A link to the "Permission Request Form" appears on the right side of the page.© 2009 American Heart Association, Inc. UrgencyLarge cohort and population-based studies reported in the last 5 years have demonstrated a higher risk ...

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Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…Across various studies, MRI has shown at least 1 infarct somewhere in the cerebrum in 46% to 81% of TIA patients. 121,122 In the past decade, new MRI techniques of diffusion and perfusion imaging have afforded new insights into the pathophysiology of cerebral ischemia. 29 -32,34 -38,40 -44,123-127 These series show convergent results regarding the frequency of DWI positivity among TIA patients; among the 19 studies including 1117 patients, the aggregate rate of DWI positivity is 39%, with frequency by site ranging from 25% to 67%.…”

mentioning

confidence: 99%

Definition and Evaluation of Transient Ischemic Attack

Easton

Saver²,

Albers³

et al. 2009

Stroke

1,592

563

View full text Add to dashboard Cite

show abstract

“…Certainly, the high prevalence of AII reported in patients with CAA may be supportive of this hypothesis. 5 Genetic factors, such as apolipoprotein E genotype, have been shown to not only modulate the relationship between vascular lesions and dementia but also determine the expression of small vessel disease such as the distribution of CMB. 22,23 Although it is possible that the association between AII and dementia may be influenced by genetic factors or underlying amyloid angiopathy, these remain hypotheses and require confirmation in further studies.…”

Section: October 2015mentioning

confidence: 99%

“…Hence, the introduction of the term silent stroke denotes an infarct with the absence of temporally correlated stroke-like symptoms. 3,4 The prevalence of silent brain infarcts varies from 8% to 28%, increases with age, 3,5,6 and is associated with increased risk of subsequent stroke, as well as cognitive impairment. 4 The study of silent stroke has been largely limited to imaging of chronic infarcts because of the small number of studies using diffusion-weighted imaging (DWI), which detects acute infarcts.…”

mentioning

confidence: 99%

Prevalence and Risk Factors of Acute Incidental Infarcts

Saini

Suministrado

Hilal

et al. 2015

Stroke

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Background and Purpose-The study of silent stroke has been limited to imaging of chronic infarcts; acute incidental infarcts (AII) detected on brain magnetic resonance imaging have been less investigated. This study aims to describe prevalence and risk factors of AII in a community and a clinic-based population. Methods-Subjects were drawn from 2 ongoing studies: Epidemiology of Dementia in Singapore study, which is a subsample from a population-based study, and a clinic-based case-control study. Subjects from both studies underwent similar clinical and neuropsychological assessments and brain magnetic resonance imaging. Prevalence of AII from these studies was determined. Subsequently, risk factors of AII were examined using multivariable logistic regression models. Results-AII were seen in 7 of 623 (1.2%) subjects in Epidemiology of Dementia in Singapore (mean age, 70.9±6.8 years; 45% men) and in 12 of 389 (3.2%) subjects (mean age, 72.1±8.3 years; 46% men) in the clinic-based study. AII were present in 0.8% of subjects with no cognitive impairment, 1.9% of those with cognitive impairment not dementia, and 4.2% of subjects with dementia. Significant association of AII was found with cerebral microbleeds (≥5)

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“…Aside from the problem of cost, the few population studies that used MRI found very high rates of silent infarctions highlighting the problem of clinical relevance of the respective lesion(s) [11][12][13]. MRI criteria will overestimate prevalence and incidence of stroke in the general population compared to clinical criteria.…”

Section: Introductionmentioning

confidence: 99%

A Single Question about Prior Stroke versus a Stroke Questionnaire to Assess Stroke Prevalence in Populations

Berger

Hense²,

Rothdach³

et al. 2000

Neuroepidemiology

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Background: False-positive and false-negative answers to screening questions influence prevalence and incidence estimations for stroke in population studies. Despite frequent use in screening, only a few studies have examined causes and influence of incorrect self-reports. We compared the rates of false-positive and false-negative answers to a single question about prior stroke to those of the Stroke Symptom Questionnaire (SSQ), a newly developed instrument based on 6 symptom questions. Differences in stroke prevalence estimations and risk factors for incorrect reports are described. Methods: The MEMO study (Memory and Morbidity in Augsburg Elderly) examines cognitive function and neurodegenerative diseases in an elderly population (n = 384) in southern Germany. All participants filled in the symptom questionnaire, received a neurological examination and a neuropsychological test battery. Medical records were obtained for event validation of subjects positive on screening and those negative on screening with symptoms suggesting a cerebrovascular event during examination. Results: Prevalence of total stroke was 5.3% using a single screening question and 6.8% using the questionnaire. The false-negative rate was higher for the single-question approach (34.2 versus 10.5%). It was strongly influenced by gender and cognitive function. The questionnaire had a higher false-positive rate than the single question. Based on the results, we established question combinations that best served three different research scenarios (frequency estimation, risk factor analysis, control selection), relevant to stroke research in population studies. Conclusions: A single screening question for stroke in the past with event validation by medical records underestimates stroke frequency in population studies by about 30%. Use of a number of questions for key symptoms combined with a general stroke question, as in the SSQ, improves the completeness of event ascertainment and allows the detection of stroke and transient ischemic attack at the same time.

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Prevalence and Associations of MRI-Demonstrated Brain Infarcts in Elderly Subjects With a History of Transient Ischemic Attack

Cited by 29 publications

References 56 publications

Definition and Evaluation of Transient Ischemic Attack

Definition and Evaluation of Transient Ischemic Attack

Prevalence and Risk Factors of Acute Incidental Infarcts

A Single Question about Prior Stroke versus a Stroke Questionnaire to Assess Stroke Prevalence in Populations

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