• Ki-Woong Nam, Chi Kyung Kim, Tae Jung Kim, Kyungmi Oh, Moon-Ku Han, Sang-Bae Ko, and Byung-Woo Yoon.
• From the Department of Neurology (K.-W.N., T.J.K., S.-B.K., B.-W.Y.), Seoul National University Hospital, and Seoul National University College of Medicine (K.-W.N., T.J.K., S.-B.K., B.-W.Y.); Department of Neurology (C.K.K., K.O.), Korea University Guro Hospital, and Korea University College of Medicine (C.K.K., K.O.), Seoul; and Department of Neurology (M.-K.H.), Seoul National University Bundang Hospital, Seongnam, Korea.
• Neurology. 2018 Feb 27; 90 (9): e738-e744.

ObjectiveTo evaluate the relationship between fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) and early ischemic lesion recurrence (follow-up diffusion-weighted imaging [FU-DWI] [+]) in patients with lesion-negative TIA.MethodsWe recruited consecutive patients with lesion-negative TIA within 24 hours of symptom onset, who underwent follow-up MRI during the acute period. FVH was defined as a focal or serpentine high signal intensity on FLAIR images. Other potential confounders were adjusted to evaluate the relationship between FVH and FU-DWI (+). Furthermore, to compare clinical outcomes between the FU-DWI (+) and FU-DWI (-) groups, we assessed 1-year recurrent ischemic stroke or TIA.ResultsAmong 392 patients with lesion-negative TIA, 82 patients had FU-DWI (+) on the follow-up MRI. In the multivariate analysis, FVH remained an independent predictor of FU-DWI (+) (adjusted odds ratio [aOR] = 4.77, 95% confidence interval [CI] 2.45-9.29, p < 0.001). The time to initial MRI (aOR = 0.49, 95% CI = 0.33-0.70, p < 0.001) and intracranial atherosclerosis (aOR = 2.07, 95% CI = 1.10-3.92, p = 0.025) were also associated with FU-DWI (+), independent of FVH. In clinical outcomes, the FU-DWI (+) group showed more frequent 1-year recurrent ischemic stroke events than the FU-DWI (-) group (10.7% vs 3.1%, respectively, p = 0.007).ConclusionsFVH is associated with FU-DWI (+) in patients with lesion-negative TIA. As FU-DWI (+) frequently occurs during the acute period and has a subsequent worse outcome after discharge, additional radiologic or clinical markers for it are necessary.© 2018 American Academy of Neurology.

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