Transient Ischemic Attack Results in Delayed Brain Atrophy and Cognitive Decline.

Abstract:

BACKGROUND AND PURPOSE:Transient ischemic attack (TIA) initiates an ischemic cascade without resulting in frank infarction and, as such, represents a novel model to study the effects of this ischemic cascade and secondary neurodegeneration in humans. METHODS:Patients with suspected TIA underwent acute brain perfusion imaging, and those with acute ischemia were enrolled into a prospective observational study. We collected baseline and 90-day magnetic resonance imaging, including MP-RAGE (high-resolution T1 sequence) and cognitive assessment with the Montreal Cognitive Assessment. Brain morphometry and within patient statistical analysis were performed to identify changes between baseline and 90-day imaging and clinical assessments. RESULTS:Fifty patients with TIA with acute perfusion lesions were studied. All patients experienced a decrease in global cortical gray matter (P=0.005). Patients with anterior circulation TIA (n=31) also had a significant reduction in the volume of the pons (P<0.001), ipsilesional parietal lobe (P<0.001), occipital lobe (P=0.002), frontal lobe (P<0.001), temporal lobe (P=0.003), and thalamus (P=0.016). Patients with an anterior perfusion lesion on acute imaging also had a significant decrease in Montreal Cognitive Assessment between baseline and day 90 (P=0.027), which may be related to the volume of thalamic atrophy (R2=0.28; P=0.009). CONCLUSIONS:In a prospective observational study, patients with TIA confirmed by acute perfusion imaging experienced a significant reduction in global gray matter and focal structural atrophy related to the area of acute ischemia. The atrophy also resulted in a proportional decreased cognitive performance on the Montreal Cognitive Assessment. Further studies are required to identify the mechanisms of this atrophy.

journal_name

Stroke

journal_title

Stroke

authors

Bivard A,Lillicrap T,Maréchal B,Garcia-Esperon C,Holliday E,Krishnamurthy V,Levi CR,Parsons M

doi

10.1161/STROKEAHA.117.019276

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

384-390

issue

2

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.117.019276

journal_volume

49

pub_type

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