J Clin Neurol.  2013 Apr;9(2):103-110. 10.3988/jcn.2013.9.2.103.

Juxtacortical Spots on Fluid-Attenuated Inversion Recovery Images in Cryptogenic Transient Ischemic Attack

• Kim DE
• Choi MJ
• Kim JT
• Chang J
• Choi SM
• Lee SH
• Park MS
• Cho KH

• KMID: 2179169
• DOI: http://doi.org/10.3988/jcn.2013.9.2.103

Abstract

BACKGROUND AND PURPOSE
Juxtacortical spots are detected frequently on fluid-attenuated inversion recovery (FLAIR) images, but have not been extensively researched in patients with transient ischemic attack (TIA). We hypothesized that juxtacortical spots on FLAIR images are partly associated with right-to-left shunt (RLS) in TIA without clear etiology. The possibility of an association between the presence of RLS and juxtacortical spots on FLAIR images in patients with TIA without clear etiology was investigated, and the imaging findings of patients with and without RLS were compared.
METHODS
This was a retrospective study of TIA patients who visited our tertiary stroke center consecutively within 72 hours of TIA onset. Cryptogenic TIA was defined as no clear etiology despite a routine diagnostic workup. The presence of RLS was examined by transcranial Doppler with an agitated saline test or transesophageal echocardiography. Juxtacortical spots were defined as small and round hyperintensities in the juxtacortex on FLAIR images, excluding white-matter hyperintensities.
RESULTS
Of the 132 patients with cryptogenic TIA examined for this study, 70 (53.0%) had RLS. Juxtacortical spots on FLAIR images were detected more frequently in patients with RLS than in those without. The independent factors for the presence of juxtacortical spots were RLS [odds ratio (OR)=3.802, 95% confidence interval (95% CI)=1.74-8.2; p=0.001] and age (OR=1.058, 95% CI=1.01-1.10; p=0.004) by multivariate analysis. The number of juxtacortical spots was significantly higher among patients with a moderate-to-large RLS than in those with a small or no RLS.
CONCLUSIONS
The findings of the present study demonstrate a significant association between the presence of RLS and the occurrence of juxtacortical spots on FLAIR images in patients with cryptogenic TIA.

Keyword

right-to-left shunt; juxtacortical spots; deep white-matter lesions; patent foramen ovale; FLAIR; TIA

MeSH Terms

Dihydroergotamine
Echocardiography, Transesophageal
Foramen Ovale, Patent
Humans
Ischemic Attack, Transient
Multivariate Analysis
Retrospective Studies
Stroke
Dihydroergotamine

Figure

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  Fig. 1 Imaging findings of a 45-year-old woman with transient left hemiparesis. (A) Juxtacortical spots on FLAIR images (arrows). (B) Normal DWI. (C) Multiple high-intensity transient signals during contrast TCD monitoring of the MCA. DWI: diffusion-weighted imaging, FLAIR: fluid-attenuated inversion recovery, TCD: transcranial Doppler.

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