From the Neurology Residency Training Program (Y.S.), McGill University, Montreal, QC, Canada.
Department of Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel (J.O., R.V., A.F.), Soroka Medical Center, Beer-Sheva, Israel.
Stroke. 2019 May;50(5):1266-1269. doi: 10.1161/STROKEAHA.119.025247.
Background and Purpose- The diagnosis of transient ischemic attack is challenging. Evidence of acute ischemia on MRI diffusion-weighted imaging is highly variable and confirmed in only about one-third of patients. This study investigated the significance of blood-brain barrier dysfunction (BBBD) mapping in patients with transient neurological deficits, as a diagnostic and prognostic biomarker required for risk stratification and stroke prevention. Methods- We used dynamic contrast-enhanced MRI to quantitatively map BBBD in a prospective cohort study of 57 patients diagnosed with transient ischemic attack/minor stroke and 50 healthy controls. Results- Brain volume with BBBD was significantly higher in patients compared with controls ( P=0.002). BBBD localization corresponded with the clinical presentation in 41 patients (72%) and was more extensive in patients with acute infarct on diffusion-weighted imaging ( P=0.05). Patients who developed new stroke during follow-up had a significantly greater BBBD at the initial presentation ( P=0.03) with a risk ratio of 5.35 for recurrent stroke. Conclusions- This is the first description of the extent and localization of BBBD in patients with transient ischemic attack/minor stroke. We propose BBBD mapping as a valuable tool for detection of subtle brain ischemia and a promising predictive biomarker required for risk stratification and stroke prevention.
背景与目的- 短暂性脑缺血发作的诊断具有挑战性。MRI 弥散加权成像上急性缺血的证据变化很大，仅约三分之一的患者得到证实。本研究旨在探讨脑血屏障功能障碍（BBBD）在短暂性神经功能缺损患者中的意义，作为一种诊断和预后生物标志物，用于风险分层和卒中预防。方法- 我们使用动态对比增强 MRI 在一项前瞻性队列研究中对 57 例短暂性脑缺血发作/小卒中患者和 50 例健康对照者进行了定量脑血屏障功能障碍（BBBD）图分析。结果- 与对照组相比，患者的 BBBD 脑容积明显更高（P=0.002）。BBBD 的定位与 41 例患者（72%）的临床表现相对应，在弥散加权成像上有急性梗死的患者中更广泛（P=0.05）。在随访期间发生新卒中的患者在初始表现时的 BBBD 明显更大（P=0.03），复发卒中的风险比为 5.35。结论- 这是首次描述短暂性脑缺血发作/小卒中患者的 BBBD 范围和定位。我们提出，BBBD 图分析是检测隐匿性脑缺血的有价值工具，也是用于风险分层和卒中预防的有前途的预测生物标志物。
