Abstract
Background and Aims:
TIA and minor stroke offer a massive opportunity for stroke prevention. Patients with motor or speech symptoms have a higher risk of early recurrent stroke. Many patients with transient or mild neurological deficits do not have high-risk features (eg sensory symptoms). The aim of the DOUBT study was to assess what proportion of these lower risk patients have true brain ischemia and secondarily to establish whether clinically we can predict what clinical factors predict a higher risk of brain ischemia.
Method:
DOUBT was a multicentre, international, prospective, observational, cohort study assessing the diagnosis and prognosis of patients with lower risk focal neurological symptoms. Patients aged ≥ 40, with no previous stroke, with either very brief (<5 minutes) motor or speech symptoms, or non-motor or speech focal neurological symptoms were included. Patients had a detailed neurological assessment and an MRI brain within 7 days of onset. Proportion of patients with an acute DWI lesion on MRI was the primary outcome.
Results:
1047 patients in Canada, Europe and Australia were prospectively enrolled in the study. All patients had a detailed neurological assessment prior to undergoing MRI brain. Preliminary analysis shows 13% true brain schema rate (DWI positive). Patients were less likely to have a DWI lesion if their symptoms were fully resolved at assessment (RR 0.57, 95%CI: 0.38-0.79, p <0.001), if they reported any psychological stress (RR 0.57: 0.33-0.99, p=0.04) or if male (RR 0.58, 0.42-0.81, p=0.001). Patients were more likely to have a DWI lesion if they had any motor or speech symptoms (RR 1.7 (0.17-2.55, p=0.009). Secondary analysis looking at detailed clinical predictors of DWI lesions status will be presented.
Conclusion:
We found a low but real risk of true brain ischemia in these lower risk patients. Further analysis is needed to explain why woman are more likely to have DWI lesions with low risk symptoms. Detailed neurological assessment may help us stratify these patients further.