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(Stroke. 2004;35:742.)
© 2004 American Heart Association, Inc.

Original Contributions

Silent Brain Infarcts in Patients With Manifest Vascular Disease

Janneke L.P. Giele, MsC; Theo D. Witkamp, MD; Willem P.T.M. Mali, MD, PhD Yolanda van der Graaf, MD, PhD for the SMART Study Group

From the Julius Center for Health Sciences and Primary Care (J.L.P.G., Y.v.d.G.) and Department of Radiology (T.D.W., W.P.T.M.M.), University Medical Center Utrecht, Utrecht, Netherlands.

Correspondence to Dr Y. van der Graaf, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HP D 01 335, PO BOX 85500, 3508 GA Utrecht, Netherlands. E-mail y.vandergraaf{at}jc.azu.nl

Background and Purpose— Silent infarcts are frequently found on MRIs of brains of healthy elderly persons (aged >60 years). The purpose of this study was to investigate the prevalence and determinants of silent infarcts in a population of patients with clinically manifest vascular disease.

Methods— To detect silent infarcts, MR images were made in 308 participants of the Second Manifestations of ARTerial disease (SMART) study (mean age, 58 years) without prior stroke or transient ischemic attack. These are patients referred to the University Medical Center Utrecht because of atherosclerotic vascular disease. Risk factors were assessed by questionnaire and by physical, ultrasonographic, and laboratory examinations.

Results— Silent infarcts were found in 51 patients (17%). Most infarcts (62%) were located in white matter, 20% in basal ganglia, 14% in brain stem and cerebellum, and 4% in cortical area. Categorical determinants for presence of silent infarct(s) that remained (borderline) significant after adjustment for age were hypertension (odds ratio [OR]=2.2; 95% CI, 1.2 to 4.2), abdominal aortic aneurysm (OR=2.4; 95% CI, 0.9 to 6.4), severe renal failure (OR=7.3; 95% CI, 2.1 to 25.2), and hyperhomocysteinemia (OR=2.6; 95% CI, 1.1 to 5.9).

Conclusions— Patients with manifest vascular disease are at risk for silent infarcts at a younger age. In particular, patients with the aforementioned risk factors should be considered for treatment or (secondary) prevention.

Key Words: cerebral infarction • epidemiology • magnetic resonance imaging

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