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(Stroke. 2008;39:2919.)
© 2008 American Heart Association, Inc.

Editorials

Silent Cerebral Infarction

Are We Listening?

Kenneth Rockwood, MD Gordon Gubitz, MD

From Divisions of Geriatric Medicine (K.R.) and Neurology (K.R., G.G.), Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax, Canada.

Correspondence to Kenneth Rockwood, Centre for Health Care of the Elderly, 1421-5955 Veterans’ Memorial Lane, Halifax, NS, Canada, B3H 2E1. E-mail Kenneth.Rockwood@Dal.ca

Key Words: cognitive impairment • silent ischemia • complexity

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

See related article, pages 2929–2935.

The clinical event of stroke is not always a good guide to the existence of cerebral infarction. The advent of widespread neuroimaging has made this clear: up to one-third of patients with TIA and no physical examination changes have infarcts on scans.¹ These patients are at even higher risk for subsequent stroke¹ as are other patients with silent cerebral infarction.² In consequence, silent cerebral ischemia is recognized as part of a spectrum of cerebrovascular disease, which also includes TIA to stroke. In this issue of Stroke, Das et al³ contribute to our understanding of silent cerebral infarction by evaluating its prevalence and correlates infarcts in the Framingham Offspring study. They report a prevalence of 10.7% among >2000 mid-life (mean age, 61 years), community-dwelling people who were clinically stroke-free. Das et al³ propose that only some vascular risk factors are linked to silent cerebral infarction.

The strengths of the Framingham data are well-known, and this report from the Offspring study joins what are literally generations of others from that impressive investigation in building a better understanding of the interplay between vascular risk factors and adverse events. Inevitably, the results raise additional questions. Some, such as understanding the impact of silent cerebral infarction on outcomes in this sample—ie, what difference did these silent infarcts make to those who had them?—accept the premises of the study. But there is merit, too, in pursuing other questions that arise from these data, even when these questions reflect uncertainty . . . [Full Text of this Article]

Related Article:

Prevalence and Correlates of Silent Cerebral Infarcts in the Framingham Offspring Study

Rohit R. Das, Sudha Seshadri, Alexa S. Beiser, Margaret Kelly-Hayes, Rhoda Au, Jayandra J. Himali, Carlos S. Kase, Emelia J. Benjamin, Joseph F. Polak, Christopher J. O'Donnell, Mitsuhiro Yoshita, Ralph B. D'Agostino, Sr, Charles DeCarli, and Philip A. Wolf
Stroke 2008 39: 2929-2935. [Abstract] [Full Text] [PDF]