Data from CT Scans: The Significance of Silent Cerebral Infarction and Atrophy

An, Nicolaides; Papadakis, Konstantinos; Grigg, Michael J.; Al-Kutoubi, Aghiad; Williams, Michael; Deacon, D. F. S.

doi:10.1007/978-1-4612-3776-1_16

Cited by 8 publications

(8 citation statements)

References 37 publications

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“…7 -20 -24 In patients with a history of transient ischemic attacks or amaurosis fugax, the rate of silent cerebral infarction has ranged from 0% to 35%'-7 and may be higher among those with vertebrobasilar TIAs. 25 In patients with a history of cerebral infarction, the rate of silent infarction identified by CT was 33% in an Italian stroke population, 26 10% in the Framingham stroke population, 27 and 11% in the Stroke Data Bank population. 28 Even in patients with coronary artery disease, silent cerebral infarction is not infrequent.…”

Section: Discussionmentioning

confidence: 99%

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Brott

Tomsick

Feinberg

et al. 1994

Stroke

123

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Background and Purpose In a group of patients with highgrade asymptomatic carotid artery stenosis, we prospectively determined the prevalence and radiological characteristics of clinically asymptomatic brain infarction evident on computed tomography. Risk factors and extent of carotid disease were also determined.Methods Patients randomized into the Asymptomatic Carotid Atherosclerosis Study (ACAS) underwent a neurological history, a detailed stroke/transient ischemic attack questionnaire, and a detailed neurological examination. Computed tomography scans were examined by standardized criteria developed as part of a quality-control program supervised by a neuroradiologist. The presence, location, and size of all cerebral infarctions evident by computed tomography were determined.Results Among 1132 patients, 848 had no history of stroke or transient ischemic attack. One hundred twenty-six patients (15%) had a silent infarct; 95 (11%) had one, 24 (3%) had two,

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Section: Discussionmentioning

confidence: 99%

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Brott

Tomsick

Feinberg

et al. 1994

Stroke

123

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“…Infarcts are also common in groups of patients with transient retinal or hemispheric ischemic attacks who have been studied by CT [1,[3][4][5][6][7][8][9] (table 2). Bogousslavsky and Regli [4,7] have dubbed these infarcts 'CITS', that is, cerebral infarcts with transient signs.…”

Section: Frequency Of Detection By Computed Tomography (Ct)mentioning

confidence: 99%

“…Some data are available on patients who have had no recognized brain symptoms relevant to the infarcts but who have had neuroimaging evaluation [1][2][3] (table 1). These patients have usually been those evaluated for extracranial vascular disease involving the carotid arter ies and those who have infarcts found in the opposite hemisphere to symptomatic transient ischemic attacks (TIAs).…”

Section: Frequency Of Detection By Computed Tomography (Ct)mentioning

confidence: 99%

Silent Brain Infarcts

Caplan¹

1994

Cerebrovasc Dis

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Silent brain infarcts are infarcts found by neuroimaging or necropsy without a history of stroke. The symptoms may have been unrecognized, forgotten by the patient, or ischemic symptoms may have been only transient. Silent infarcts are common. Infarcts are found on computed tomography (CT) in about 15% of patients with asymptomatic carotid artery lesions. Cerebral infarcts with transient signs (CITS) are noted on CT in about 25% of patients with spells of transient monocular blindness, and a comparable percentage of patients with transient hemispheric attacks. About 10% of patients with symptomatic strokes also have other infarcts found by CT that do not correlate with symptoms. Magnetic resonance imaging (MRI) is much more sensitive for detecting silent infarcts than CT. Among three series of transient ischemic attack (TIA) patients, 75% of 103 patients had silent infarcts on MRI compared to only 27% who had infarcts detected by CT. Many silent infarcts are small and deep; larger silent infarcts are probably more often found in the right cerebral hemisphere. In patients with CITS, infarction is more common when TIAs are longer than 1 h and clear slowly. In patients with carotid artery occlusive disease, silent infarcts correlate with the severity of stenosis and are probably more common in patients with ulcerative lesions. Embolism, both cardiac and intra-arterial, and lacunar infarction are probably the two most common mechanisms of silent infarction. Patients with silent infarcts differ little in respect to risk factors from patients with TIAs and from patients with symptomatic infarcts. The presence of silent and symptomatic brain infarcts gives clinicians some information about the natural history of the patient''s cerebrovascular disease. Patients with cerebrovascular disease should be characterized by: (1) symptoms (none, transient retinal, hemispheric, hemianopic, brainstem/cerebellar or strokes); (2) state of the brain (normal, stunned, infarcted), and (3) the nature, location, and severity of cardiovascular-blood diseases) that have caused or threaten stroke.

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“…8 -18 TIA patients with brain infarcts on CT have been reported to be older and more likely to have hypertension, carotid stenosis, and ulceration of carotid plaques than TIA patients without such infarcts. 8,11,18 TIA patients with infarcts are believed to be at a greater risk of major vascular events. 15 Poor collateral circulation and shorter survival times for these patients have also been reported.…”

Section: Discussionmentioning

confidence: 99%

“…8,10 -16 It has been suggested that TIA patients with infarcts on CT are at an increased risk for fatal and nonfatal vascular events compared with those without such infarcts. [11][12][13][15][16][17][18] MRI is more sensitive than CT in detection of brain infarcts 19 and in differentiation of infarcts from diffuse white matter changes or leukoaraiosis often seen on neuroimaging studies of elderly or hypertensive subjects. 20 -22 This results in frequent detection of brain infarcts in asymptomatic individuals.…”

mentioning

confidence: 99%

Prevalence and Associations of MRI-Demonstrated Brain Infarcts in Elderly Subjects With a History of Transient Ischemic Attack

Bhadelia¹,

Anderson²,

Polak³

et al. 1999

Stroke

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Background and Purpose-MRI is more sensitive than CT, but the significance of brain abnormalities seen on MR images obtained in older subjects with transient ischemic attack (TIA) is not clear. We studied the prevalence and risk factors associated with MRI-demonstrated infarcts in elderly subjects with a history of TIA. Methods-Participants of the Cardiovascular Health Study, aged 65 years or more and without prior stroke, were studied with brain MRI (nϭ3456). The prevalence of brain infarcts (Ն3 mm) on MRI was determined in subjects with and without TIA. The cardiovascular risk factors and clinical and subclinical cardiovascular disease associated with MRI infarcts were studied in subjects with TIA. Results-Subjects with TIA (nϭ100) had a higher prevalence of MRI infarcts than subjects without TIA (46% versus 28%;PϽ0.001). The unadjusted odds ratio for having MRI infarcts in subjects with TIA was 2.20 (95% CI, 1.47 to 3.30) and remained significantly elevated after adjustments for risk factors and cerebrovascular disease (odds ratio, 1.86; 95% CI, 1.23 to 2.83). In subjects with TIA, diastolic blood pressure (Pϭ0.01) and internal carotid artery intima-media thickness (Pϭ0.01) were the only factors predictive of the presence of MRI infarcts by stepwise logistic regression analysis. Conclusions-MRI infarcts are imaging manifestations of clinically important cerebrovascular disease in subjects with a history of TIA, given their increased prevalence and positive association with increased diastolic blood pressure and internal carotid artery intima-media thickness. (Stroke. 1999;30:383-388.)

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Data from CT Scans: The Significance of Silent Cerebral Infarction and Atrophy

Cited by 8 publications

References 37 publications

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study.

Silent Brain Infarcts

Prevalence and Associations of MRI-Demonstrated Brain Infarcts in Elderly Subjects With a History of Transient Ischemic Attack

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