Target Sign Found for Stroke

Pathological vertebral artery (VA) abnormalities can be identified in acute vestibular syndrome (AVS) patients with the use of an axial T2 MRI scan, according to Jorge Kattah, MD, a neurologist at OSF Saint Francis Medical Center in Peoria, IL. This study will be presented in a poster session on Apr. 18 at the American Academy of Neurology meeting in Washington, DC.

While Kattah and colleagues had access to 223 AVS patients from a single stroke referral center, only 145 of them had T2 MRI scan data. The reports were examined by 2 professionals, one being a blinded neuro-radiologist and the other a non-blinded clinician. The pair was looking for hyper-intensity or asymmetry (target sign) in the V4 segments.

The results showed that 71 patients had a stroke while the remaining 74 were diagnosed with vestibular neuritis (VN). Of the stroke sufferers, 42.2% (30/71) had hyper-intensity while 8.1% (6/74) of VN patients were diagnosed with the same.

“Odds ratio of stroke in patients with a “target sign” was 8.29 (95% CI 3.18-21.6),” the authors wrote. “Among stroke patients with negative initial DWI MRI 41.7% (5/12) had a VA V4 segment hyper-intensity.”

It was noted that all of the target signs found in the stroke patients, except for one, “were ipsilateral to the side of final stroke.”

While pathologic VA abnormalities were determined in about half of the stroke patients’ hyper-intensity or target sign, the findings were uncommon in the VN group. The team advised that if clinicians find the VA target sign present, another DWI MRI should be done in order to prevent missing a ischemic cerebrovascular syndrome diagnosis.