Stroke, Vol 25, 2384-2390, Copyright © 1994 by American Heart Association
A Boon, J Lodder, L Heuts-van Raak and F Kessels
BACKGROUND AND PURPOSE: We wanted to establish independent associations of
various clinical variables, computed tomographic (CT) scan features,
presenting stroke subtypes, and outcome with the presence of silent
infarcts on CT. METHODS: We studied 755 consecutive patients in a
prospective registration of patients with first-ever supratentorial
atherothrombotic, cardioembolic, or lacunar stroke or stroke of
undetermined cause by multiple logistic regression analysis. RESULTS: Two
hundred six patients (27%) with a first symptomatic territorial or small
deep ischemic stroke had one or more silent infarcts on CT. Of all silent
lesions, 169 (82%) were small and deep. Silent infarcts were significantly
more strongly associated with a lacunar than atherothrombotic (odds ratio
[OR], 1.59; 95% confidence interval [CI], 1.02 to 2.47; P = .039) or
cardioembolic (OR, 1.89; 95% CI, 1.2 to 2.99; P = .005) index stroke.
Silent territorial lesions were more strongly associated with cardioembolic
than with lacunar stroke but not with atherothrombotic stroke. In this
respect, no differences were found between the atherothrombotic and
undetermined-cause group. Advanced age and hypertension were the only risk
factors that were significantly associated with silent infarcts (OR, 1.76;
95% CI, 1.14 to 2.71; P = .011; and OR, 1.58; 95% CI, 1.13 to 2.21; P =
.007; respectively), mainly because of a strong independent association of
these risk factors with silent small deep infarcts (OR, 1.75; 95% CI, 1.10
to 2.79; P = .018; and OR, 1.57; 95% CI, 1.09 to 2.24; P = .014;
respectively). A cardioembolic source or atrial fibrillation in specific
was not independently associated with any type or number of silent
infarcts. Significant carotid stenosis (diameter reduction > 50%) was
not significantly associated with any type of silent lesion. Initial severe
handicap (Rankin Scale score > 3), 30-day case fatality rate, and 1-year
mortality were not affected by the presence of silent infarcts.
CONCLUSIONS: The strong association of silent small deep lesions with first
symptomatic small deep infarcts suggests a common underlying mechanism
(presumably small-vessel vasculopathy), whereas cardiogenic embolism and
large-vessel thromboembolism are the most likely causes in both silent and
first symptomatic territorial infarcts. Single or multiple silent infarcts
do not predict a cardioembolic stroke mechanism in first symptomatic
supratentorial brain infarcts. As silent infarcts do not predict the cause
of carotid embolic stroke in first symptomatic brain infarcts, their
presence should not influence the decision on carotid surgery. Silent
infarcts do not affect the degree of initial handicap, 30-day case
fatality, or 1-year mortality. The significance of silent infarcts for
predicting possible future cognitive decline and risk of recurrent stroke
deserves further study.
ARTICLES
Silent brain infarcts in 755 consecutive patients with a first-ever supratentorial ischemic stroke. Relationship with index-stroke subtype, vascular risk factors, and mortality
Department of Neurology, St-Anna Hospital, Geldrop, Netherlands.
This article has been cited by other articles:
 |
|
 |
|
  J. Putaala, M. Kurkinen, V. Tarvos, O. Salonen, M. Kaste, and T. Tatlisumak Silent brain infarcts and leukoaraiosis in young adults with first-ever ischemic stroke Neurology, May 26, 2009; 72(21): 1823 - 1829. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. B. Slot, E. Berge, and J. Wardlaw Haemorrhagic transformation of a recent silent cerebral infarct during thrombolytic stroke treatment BMJ Case Reports, November 20, 2008; 2008(nov12_1): bcr0620080266 - bcr0620080266. [Abstract] [Full Text]
|
|
|
|
 |
|
 K. Yamada, Y. Nagakane, H. Sasajima, M. Nakagawa, K. Mineura, T. Masunami, K. Akazawa, and T. Nishimura Incidental Acute Infarcts Identified on Diffusion-Weighted Images: A University Hospital-Based Study AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): 937 - 940. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Lecrux, C. McCabe, C. J. Weir, L. Gallagher, J. Mullin, O. Touzani, K. W. Muir, K. R. Lees, and I. M. Macrae Effects of Magnesium Treatment in a Model of Internal Capsule Lesion in Spontaneously Hypertensive Rats Stroke, February 1, 2008; 39(2): 448 - 454. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele, C. S. Kidwell, S. Starkman, S. L. Selco, V. Rajajee, T. Razinia, and J. L. Saver Angiotensin 2 type 2 receptor activity and ischemic stroke severity Neurology, September 27, 2005; 65(6): 851 - 854. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Grips, O. Sedlaczek, H. Bazner, M. Fritzinger, M. Daffertshofer, and M. Hennerici Supratentorial Age-Related White Matter Changes Predict Outcome in Cerebellar Stroke Stroke, September 1, 2005; 36(9): 1988 - 1993. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Tejada, E. Diez-Tejedor, L. Hernandez-Echebarria, and O. Balboa Does a Relationship Exist Between Carotid Stenosis and Lacunar Infarction? Stroke, June 1, 2003; 34(6): 1404 - 1409. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Aben, F Verhey, J Strik, R Lousberg, J Lodder, and A Honig A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction J. Neurol. Neurosurg. Psychiatry, May 1, 2003; 74(5): 581 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Aben, F. Verhey, R. Lousberg, J. Lodder, and A. Honig Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as Screening Instruments for Depression in Stroke Patients Psychosomatics, October 1, 2002; 43(5): 386 - 393. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. de Jong, F. Kessels, and J. Lodder Two Types of Lacunar Infarcts: Further Arguments From a Study on Prognosis Stroke, August 1, 2002; 33(8): 2072 - 2076. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Bernick, L. Kuller, C. Dulberg, W.T. L. Jr., T. Manolio, N. Beauchamp, and T. Price Silent MRI infarcts and the risk of future stroke: The cardiovascular health study Neurology, October 9, 2001; 57(7): 1222 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Cupini, M. Diomedi, F. Placidi, M. Silvestrini, and P. Giacomini Cerebrovascular Reactivity and Subcortical Infarctions Arch Neurol, April 1, 2001; 58(4): 577 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. DeCarli, T. Reed, B. L. Miller, P. A. Wolf, G. E. Swan, and D. Carmelli Impact of Apolipoprotein E {epsilon}4 and Vascular Disease on Brain Morphology in Men From the NHLBI Twin Study Stroke, August 1, 1999; 30(8): 1548 - 1553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. DeCarli, B. L. Miller, G. E. Swan, T. Reed, P. A. Wolf, J. Garner, L. Jack, and D. Carmelli Predictors of Brain Morphology for the Men of the NHLBI Twin Study Stroke, March 1, 1999; 30(3): 529 - 536. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Uehara, M. Tabuchi, and E. Mori Risk Factors for Silent Cerebral Infarcts in Subcortical White Matter and Basal Ganglia Stroke, February 1, 1999; 30(2): 378 - 382. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Nakane, S. Ibayashi, K. Fujii, S. Sadoshima, K. Irie, T. Kitazono, and M. Fujishima Cerebral blood flow and metabolism in patients with silent brain infarction: occult misery perfusion in the cerebral cortex J. Neurol. Neurosurg. Psychiatry, September 1, 1998; 65(3): 317 - 321. [Abstract] [Full Text]
|
|
|
|
|
|
S. Kobayashi, K. Okada, H. Koide, H. Bokura, and S. Yamaguchi Subcortical Silent Brain Infarction as a Risk Factor for Clinical Stroke Stroke, October 1, 1997; 28(10): 1932 - 1939. [Abstract] [Full Text]
|
|
|
|
|
|
M. van Zagten, J. Boiten, F. Kessels, and J. Lodder Significant Progression of White Matter Lesions and Small Deep (Lacunar) Infarcts in Patients With Stroke Arch Neurol, July 1, 1996; 53(7): 650 - 655. [Abstract] [PDF]
|
|
|
|
|
|
A. Boon, J. Lodder, E. Cheriex, and F. Kessels Risk of Stroke in a Cohort of 815 Patients With Calcification of the Aortic Valve With or Without Stenosis Stroke, May 1, 1996; 27(5): 847 - 851. [Abstract] [Full Text]
|
|
|
|
|
|
A. Chamorro, A. Saiz, N. Vila, C. Ascaso, R. Blanc, M. Alday, and J. Pujol Contribution of Arterial Blood Pressure to the Clinical Expression of Lacunar Infarction Stroke, March 1, 1996; 27(3): 388 - 392. [Abstract] [Full Text]
|
|
|
|
|
|
M. Brainin, L. M. McShane, M. Steiner, A. Dachenhausen, and A. Seiser Silent Brain Infarcts and Transient Ischemic Attacks : A Three-Year Study of First-Ever Ischemic Stroke Patients: The Klosterneuburg Stroke Data Bank Stroke, August 1, 1995; 26(8): 1348 - 1352. [Abstract] [Full Text]
|
|