By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a retained consultant for Proctor & Gamble and Pfizer.

SOURCE: Yaghi S, Rostanski SK, Boehme AK, et al. Imaging parameters and recurrent cerebral vascular events in patients with minor stroke or transient ischemic attack. JAMA Neurol 2016;73:572-578.

Recurrent cerebral vascular events (RCVEs) are one of the main determinants of outcome in patients after minor strokes and transient ischemic attacks (TIAs). The risk of recurrence is highest within 90 days and is particularly high in the first 48 hours. A number of scoring systems have been developed to attempt a prediction and stratify high-risk from low-risk patients. However, the scores have been limited because they were derived from mostly non-neurologist diagnosed TIA samples and their applicability to patients seen by current neurology stroke teams is questionable. The objective of this study was to determine predictors of early recurrent cerebral vascular events among patients with TIA or minor stroke, defined as an NIHSS of 0 to 3. This retrospective cohort study was conducted at two tertiary care centers, Columbia University in New York, and Tulane University in New Orleans, from 2010 until 2014. All patients were diagnosed with a TIA or minor stroke by a neurologist when they presented to the ED. The primary outcome was a recurrent neurological event unexplained by any other medical condition. Of 1,258 total patients, 71 experienced recurrent events. In a multivariate model of prediction for recurrent infarct, the significance predictors were 1) infarcts on neuroimaging (CT or diffusion-weighted MRI), with an odds ratio of 1.75, and 2) large vessel disease etiology, with an odds ratio of 6.69. When both predictors were present, there was a further increase in the risk of patients experiencing recurrent cerebral vascular events. When neither predictor was present, the rate of recurring events was extremely low (up to 2%). Patients who experienced recurrent events were less likely to be discharged.