Background: The newly proposed transient ischemic attack (TIA) definition demands for MRI exclusion of infarction. Due to limited resources other tools than MRI predicting tissue infarction would be valuable. We hypothesized that ABCD2 risk score is a valid screening tool for diffusion-weighted imaging (DWI) lesions. Methods: TIA patients were prospectively enrolled in an observational MRI study to receive acute and follow-up stroke MRI. ABCD2 scores were calculated, and sociodemographics and risk factors were recorded. Results: One hundred and thirty-two TIA patients were enrolled over nine months. Five patients were excluded due to different diagnosis. Forty-five of the 127 remaining patients showed acute ischemic lesions on DWI. Median ABCD2 scores for DWI-negative and -positive patients were 4 and 5, respectively. Ordinal, trichotomized and dichotomized ABCD2 were significantly associated to DWI. Univariate analysis of single score items and other risk factors demonstrated unilateral weakness, duration of symptoms and smoking as predictive for DWI restrictions. In multivariate analysis unilateral weakness remained significant. Conclusions: High-risk ABCD2 score due to the impact of hemiparesis is associated with the occurrence of DWI lesions but is still not accurate enough for a reliable differentiation of cerebrovascular events with and without MRI lesions.

1.
Kidwell CS, Alger JR, Di Salle F, et al: Diffusion MRI in patients with transient ischemic attacks. Stroke 1999;30:1174–1180.
2.
Rovira A, Rovira-Gols A, Pedraza S, Grivé E, Molina C, Alvarez-Sabin J: Diffusion-weighted MR imaging in the acute phase of transient ischemic attacks. AJNR Am J Neuroradiol 2002;23:77–83.
3.
Easton JD, Saver JL, Albers GW, et al: Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009;40:2276–2293.
4.
Adeoye O, Heitsch L, Moomaw CJ, et al: How much would performing diffusion-weighted imaging for all transient ischemic attacks increase MRI utilization? Stroke 2010;41:2218–2222.
5.
Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al: Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007;369:283–292.
6.
Ay H, Arsava EM, Johnston SC, et al: Clinical- and imaging-based prediction of stroke risk after transient ischemic attack: the CIP model. Stroke 2009;40:181–186.
7.
Calvet D, Touzé E, Oppenheim C, Turc G, Meder J, Mas J: DWI lesions and TIA etiology improve the prediction of stroke after TIA. Stroke 2009;40:187–192.
8.
Giles MF, Albers GW, Amarenco P, et al: Addition of brain infarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients. Stroke 2010;41:1907–1913.
9.
NINDS: Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. Stroke 1990;21:637–676.
10.
Hotter B, Pittl S, Ebinger M, et al: Prospective study on the mismatch concept in acute stroke patients within the first 24 h after symptom onset – 1000Plus study. BMC Neurol 2009;9:60.
11.
Redgrave JNE, Coutsts SB, Schulz UG, Briley D, Rothwell PM: Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack. Stroke 2007;38:1482–1488.
12.
Purroy F, Begué R, Quílez A, et al: The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients. Stroke 2009;40:2229–2232.
13.
Crisostomo RA, Garcia MM, Tong DC: Detection of diffusion-weighted MRI abnormalities in patients with transient ischemic attack: correlation with clinical characteristics. Stroke 2003;34:932–937.
14.
Inatomi Y, Kimura K, Yonehara T, Fujioka S, Uchino M: DWI abnormalities and clinical characteristics in TIA patients. Neurology 2004;62:376–380.
15.
Oppenheim C, Lamy C, Touzé E, et al: Do transient ischemic attacks with diffusion-weighted imaging abnormalities correspond to brain infarctions? AJNR Am J Neuroradiol 2006;27:1782–1787.
16.
Fiehler J, Foth M, Kucinski T, et al: Severe ADC decreases do not predict irreversible tissue damag in humans. Stroke 2002;33:79–86.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.