Usefulness of hyperintense acute reperfusion marker sign in patients with transient neurologic symptom

Abstract

It aimed to investigate the incidence and final diagnosis of hyperintense acute reperfusion marker (HARM) signs in patients initially suspected of having a transient ischemic attack (TIA). In retrospective manner, a series of consecutive series of patients who arrived at the emergency department and was initially assessed as TIA within 12 hours of symptom onset between July 2015 and December 2016 were enrolled. Conventional magnetic resonance imaging protocol including diffusion-weighted imaging (DWI) and pre- and post-contrast fluid attenuation inversion recovery imaging (FLAIR) was conducted to evaluate the ischemic lesion and prognosis. Through the review of medical records and imaging studies, their final diagnosis and its association with HARM signs on post-contrast FLAIR were investigated. A total of 174 subjects were enrolled (mean age, 64.0 ± 12.9 years old; male, 54.6%; DWI lesion, 17.8%). HARM signs were observed in 18 (10%) patients, and their final diagnoses were classified as true TIA (n = 11, 61%), seizure (2, 11%), posterior reversible encephalopathy (2, 11%), reversible cerebral vascular constriction (1, 6%) and unclassified encephalopathy (2, 11%). The co-occurrence of HARM and DWI lesions were observed in 7 subjects which were 6 subjects of true TIA (ischemic stroke) and 1 subject with RCVS related ischemic stroke. The observation of HARM sign would be helpful to confirm the ischemic insult and distinguish the other disease. Abbreviations: CSF = cerebrospinal fluid, DWI = diffusion-weighted imaging, ED = emergency department, FALIR = fluid attenuation inversion recovery imaging, HARM = hyperintense acute reperfusion marker, IQR = interquartile range, MRI = magnetic resonance imaging, PRES = posterior reversible encephalopathy, RCVS = reversible cerebral vasoconstriction syndrome, SD = standard deviation, TIA = transient ischemic attack, TNS = transient neurologic symptom.