Stroke, Vol 25, 97-104, Copyright © 1994 by American Heart Association
HS Jorgensen, H Nakayama, HO Raaschou, J Gam and TS Olsen
BACKGROUND AND PURPOSE--Our objective was to study age-specific prevalence,
computed tomographic (CT) characteristics, risk factors, and the prognostic
influence on stroke outcome of silent infarction in acute stroke patients.
METHODS--The study was prospective and community- based and included 801
acute stroke patients, of whom 587 had first- ever stroke. A CT scan was
performed in 500 (85%) of the 587 patients with first-ever stroke. CT was
reviewed blindly, and infarcts were classified according to patient history
as silent or symptomatic. Patients were evaluated initially with the
Mini-Mental State Examination (MMSE) and weekly with both the Scandinavian
Stroke Scale (SSS) and the Barthel Index (BI) from the onset of stroke to
completion of rehabilitation. CT characteristics, risk factors, and stroke
outcome were compared in stroke patients with and without silent
infarction. RESULTS--The prevalence of silent infarction in patients with
first- ever stroke and recurrent strokes was similar, at 29% (group aged 0
to 54 years, 16%; 55 to 64 years, 22%; 65 to 74 years, 30%; 75 years or
older, 33%). Silent infarcts were small and subcortical. Independent risk
factors were increasing age (odds ratio [OR], 1.95 per 25 years; confidence
interval [CI], 1.19 to 3.15), hypertension (OR, 1.75; CI, 1.13 to 2.70),
claudication (OR, 1.74; CI, 1.01 to 3.00), and male sex (OR, 1.72; CI, 1.12
to 2.64); other stroke risk factors such as atrial fibrillation and former
transient ischemic attack were not independent risk factors. Patients with
and without silent infarction did not differ in frequency of prestroke home
care (P = .2). MMSE (P = .56), initial BI (P = .62) and SSS score (P =
.08), BI (P = .85) and SSS score (P = .75) after completion of
rehabilitation, or in the speed of recovery (P = .85). Length of hospital
stay, mortality rate, and discharge rate to nursing home also did not
differ between the two groups. CONCLUSIONS--This community-based study
shows that silent infarction in stroke patients is more related to certain
stroke risk factors than others and that silent infarction does not seem to
influence the prognosis of stroke.
ARTICLES
Silent infarction in acute stroke patients. Prevalence, localization, risk factors, and clinical significance: the Copenhagen Stroke Study
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
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