Affiliations: [a] Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA | [b] Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA | [c] Department of Neurology, University of Colorado, Aurora, CO, USA
Correspondence:
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Corresponding author: Dr. Neha Lodha, Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CO, 80523, USA. Tel.: +1 970 491 2772; Fax: +1 970 491 0445; E-mail: neha.lodha@colostate.edu.
Abstract: Background:Unilateral motor impairment is a key symptom used in the diagnosis of transient ischemic attack (TIA). Diffusion-weighted imaging (DWI) is a promising diagnostic tool for detecting ischemic lesions. While both motor impairments and DWI abnormalities are linked to the diagnosis of TIA, the association between these prognostic factors is not well understood. Objective:To examine the association between unilateral motor impairments and the odds of a positive DWI in TIA. Further, to determine whether the time between symptom onset and neuroimaging (delay to scan) influences the odds of a positive DWI. Methods:We used PRISMA guidelines to conduct a systematic search from 1989 to 2018. We included studies that reported number of individuals with/without unilateral motor symptoms and a positive/negative DWI. Results:Twenty-four studies from North America, Australia, Asia, and Europe were submitted to a meta-analysis. A pooled odds ratio of 1.80 (95% CI, 1.45–2.24, p = 0.00; I2 = 57.38) suggested that the odds of a positive DWI are greater in TIA individuals who experience motor symptoms as compared with those who experience no motor symptoms. Further, increasing the time delay to scan from the symptom onset (>2 days) did not influence the odds of a positive DWI as compared with an earlier scan (≤2 days). Conclusions:The current meta-analysis provides cumulative evidence from 6710 individuals with TIA that the presence of motor symptoms increases the odds of a positive DWI by two-folds. These findings transform the clinical perception into evidence-based knowledge that motor impairments elevate the risk for brain tissue damage. Unilateral motor impairments in a cerebrovascular event should increase a physician’s suspicion of detecting brain infarctions. These findings may influence the clinical management of TIA by generating faster response to motor impairments in TIA and accelerating referral to specialized stroke clinic.
Keywords: TIA, minor stroke, sensorimotor deficits, brain imaging, risk
