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(Stroke. 2005;36:2062.)
© 2005 American Heart Association, Inc.

Editorials

Brain Vascular Disease Overt and Covert

W.T. Longstreth, Jr, MD, MPH

From the Department of Neurology, Harborview Medical Center, Seattle, Wash

Correspondence to W.T. Longstreth, Jr, MD, MPH, Department of Neurology, Box 359775, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Seattle, Washington 98104-2420. E-mail wl@u.washington.edu

Key Words: extremities • vascular disease

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Work from the Leukoaraiosis and Disability (LADIS) Study Group¹ and from others characterizing brain structure and function in the elderly continue to challenge myopic views of how vascular disease affects the brain. What most often demands attention and consumes resources—patients with symptoms and signs of stroke and transient ischemic attack—represents the easily recognized tip of the iceberg whose larger underwater mass goes largely ignored. More needs to be learned about covert vascular disease that erodes brain structure and function in ways less dramatic than overt disease.

Before sophisticated imaging revealed details of brain structure, symptoms and signs defined brain vascular disease. Postmortem examinations of the brain were limited to a select group of patients but foreshadowed the existence of substantial subclinical vascular disease.² With the introduction of brain imaging, clinicians could characterize the structure of the brain in patients with acute symptoms and signs. Those with symptomatic brain vascular disease were often found on brain imaging to have other vascular lesions that had not caused acute symptoms. Brain imaging in some patients with reversible clinical syndromes such as transient ischemic attacks showed findings compatible with an acute infarct. Perhaps not surprisingly, such patients may have a prognosis different from those whose imaging is clean.³

As brain imaging, especially with magnetic resonance imaging (MRI), of those with or without symptoms and signs of brain vascular disease became more ubiquitous, the realization grew that subclinical infarcts and white matter hyperintensities were prevalent among the elderly and likely related to ischemic vascular disease. . . . [Full Text of this Article]

Related Article:

Small Vessel Disease and General Cognitive Function in Nondisabled Elderly: The LADIS Study

Wiesje M. van der Flier, Elizabeth C.W. van Straaten, Frederik Barkhof, Ana Verdelho, Sofia Madureira, Leonardo Pantoni, Domenico Inzitari, Timo Erkinjuntti, Militta Crisby, Gunhild Waldemar, Reinhold Schmidt, Franz Fazekas, Philip Scheltens on behalf of the LADIS Study Group
Stroke 2005 36: 2116-2120. [Abstract] [Full Text] [PDF]

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