Hiperintensidade vascular no flair em pacientes com ataque isquêmico transitório

• Autor(a) principal: Figueiredo, Marcelo Marinho de [UNIFESP]
• Data de Publicação: 2016
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3616377; http://repositorio.unifesp.br/handle/11600/47980
• topic: Transitory acute ischemia; Spectroscopy magnetic resonance image; Stroke; Neuroimage; Ischemia; Ataque isquêmico transitório; Espectroscopia de ressonância magnética; Acidente vascular cerebral; Neuroimagem; Isquemia

Objetives: Our objectives were to evaluate the neuroimaging characteristics of patients with transient ischemic attack who had undergone magnetic resonance imaging with focus on the presence of distal hyperintense vessels and to correlate the findings with clinical characteristics and the presence large artery stenoses or occlusion. Methods: We evaluated a database of consecutive patients admitted with transient ischemic attack from February 2009 to April 2013 who had undergone magnetic resonance imaging within 30 h of symptoms onset and intracranial and extracranialvascular imaging. We evaluated the relationship between distal hyperintense vessels, clinical presentation, vascular risk factors, neuroimaging characteristics and the presence of large artery stenosis or occlusion. Distal hyperintense vessels signals were defined on FLAIR images as focal, linear or serpentine, hyperintense signals relative to gray matter. Two neuroradiologists blinded to clinical information reached consensus regarding the presence of distal hyperintense vessels. Results: Seventy-two TIA patients were enrolled. The median time from symptoms onset to magnetic resonance imaging was 8:39 h IQ [4:21, 14:13]. Distal hyperintense vessels signals on FLAIR images were present in 12 (16.7 %) patients. The overall agreement between examiners was good (k 0.67). Patients with distal hyperintense vessels had more atrial fibrillation than those without (41.7% versus 21.7%, p=0.05) and a trend towards more congestive heart failure (8.3% versus 1.7%, p=0.2) and diabetes (41.7% versus 21.7%, p=0.1). There were no differences in the frequency of intracranial or cervical arterial stenoses, cerebral microbleeds and white matter abnormalities in patients with and without distal hyperintense vessels. In a multivariate logistic regression analysis, only atrial fibrillation had a trend to be a predictor of distal hyperintense vessels (OR=4.24, p=0.1). The statistical model to predict distal hyperintense vessels including atrial fibrillation, diabetes and congestive heart failure had a moderate fit in terms of discrimination (c statistic=0.62). Conclusion: distal hyperintense vessels signals on FLAIR images occur in patients with transient ischemic attack and might correlate with clinical variables like atrial fibrillation and not only with large vessel occlusion as previously described. The presence of distal hyperintense vessels in patients with transient ischemic attack and atrial fibrillation might be a surrogate marker for a previous large vessel occlusion spontaneously recanalized.