Silent brain infarctions in patients with first-ever stroke. A community-based study in Umbria, Italy.

Ricci, Stefano; Celani, Maria Grazia; Rosa, Francesco La; Righetti, Enrico; Duca, E; Caputo, Nevia

doi:10.1161/01.str.24.5.647

Cited by 66 publications

(54 citation statements)

References 23 publications

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“…CT studies among patients admitted with acute stroke but no history of prior stroke, for example, have demonstrated that 10% to 38% of such patients have evidence of prior infarction. 76,88,90 In 1 study, silent infarcts on CT were seen among 15% of patients with asymptomatic carotid stenosis. 91 Vermeer et al 74 reviewed the literature on MR-detected silent infarcts (n=105 original papers) in 2007.…”

Section: 88mentioning

confidence: 97%

An Updated Definition of Stroke for the 21st Century

Sacco¹,

Kasner²,

Broderick³

et al. 2013

Stroke

2,724

1,029

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Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term “stroke” is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.

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Section: 88mentioning

confidence: 97%

An Updated Definition of Stroke for the 21st Century

Sacco¹,

Kasner²,

Broderick³

et al. 2013

Stroke

2,724

1,029

View full text Add to dashboard Cite

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“…The prevalence of silent lesions in previous CT or MRI studies varies from 10% to 47%, [6][7][8][9]23,24 and populationbased studies using MRI report a prevalence of silent lesions ranging from 11% to 28%. 2,25,26 In the present study, the prevalence of silent lesions by MRI, especially those ≥3 mm, was 44.9% in control patients, which is relatively high compared with previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] The reported prevalence of silent lesions observed by MRI varies, 3,[6][7][8][9] but there is consensus that it is high in elderly subjects and in patients with risk factors for stroke (eg, hypertension and atrial fibrillation (AF)). 1,4,10,11 The importance of these silent lesions has been emphasized in reports linking them to impaired cognition 2 and depression.…”

mentioning

confidence: 99%

Aspirin Attenuates the Incidence of Silent Brain Lesions in Patients With Nonvalvular Atrial Fibrillation

Sato

Koretsune

Fukunami³

et al. 2004

Circ J

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Background Abnormal findings, including silent cerebral infarction, are frequently observed by magnetic resonance imaging (MRI) in patients with nonvalvular atrial fibrillation (NVAF); however, the prevalence and prevention strategy for these lesions have not been extensively studied. In the present study the preventive effects of aspirin on silent ischemic lesions was investigated. Methods and Results Silent lesions were counted using cranial MRI performed in 78 neurologically normal adults with sinus rhythm and in 212 patients with NVAF without a history of stroke. MRIs were repeated twice in the NVAF patients at 12-month intervals. During the first year, patients received neither antiplatelet agent nor anticoagulant; in the second year, aspirin (330 mg daily) was administered. The prevalence of lesions in the initial MRI was higher in NVAF patients (86.4%) than in sinus rhythm subjects (53.8%; p<0.001). After 12 months without aspirin, new lesions were seen in 20.6% of NVAF patients. The yearly occurrence of new lesions was decreased to 9.6% during the year of treatment with aspirin (p=0.014). Conclusions In patients with NVAF, abnormal lesions are frequently observed by MRI and aspirin treatment may be effective in preventing further small silent lesions. (Circ J 2004; 68: 410 -416)

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“…Herderschee et al 3 found silent infarction in 11% of 2329 patients participating in a secondary prevention trial, but only patients with TIA and minor stroke were included, and the study was not community-based. Ricci et al 4 found in a community-based study silent infarction to be present in 80 (38%) of 209 patients with first-ever stroke. However, only 56% of the patients had CT scan, and silent infarcts were diagnosed just as frequently as symptomatic infarcts.…”

Section: Prevalencementioning

confidence: 98%

“…Information concerning the influence of silent infarction on stroke outcome is, however, sparse. Ricci et al 4 found that poor outcome, defined as death or persistence of physical handicap, was not influenced by the presence of silent infarction. However, smaller differences in outcome or in the speed of recovery caused by silent infarction might not be recognized with these end points.…”

mentioning

confidence: 99%

Silent infarction in acute stroke patients. Prevalence, localization, risk factors, and clinical significance: the Copenhagen Stroke Study.

Jørgensen

Nakayama

Raaschou

et al. 1994

Stroke

114

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Our objective was to study age-specific prevalence, computed tomographic (CT) characteristics, risk factors, and the prognostic influence on stroke outcome of silent infarction in acute stroke patients. The study was prospective and community-based and included 801 acute stroke patients, of whom 587 had first-ever stroke. A CT scan was performed in 500 (85%) of the 587 patients with first-ever stroke. CT was reviewed blindly, and infarcts were classified according to patient history as silent or symptomatic. Patients were evaluated initially with the Mini-Mental State Examination (MMSE) and weekly with both the Scandinavian Stroke Scale (SSS) and the Barthel Index (BI) from the onset of stroke to completion of rehabilitation. CT characteristics, risk factors, and stroke outcome were compared in stroke patients with and without silent infarction. The prevalence of silent infarction in patients with first-ever stroke and recurrent strokes was similar, at 29% (group aged 0 to 54 years, 16%; 55 to 64 years, 22%; 65 to 74 years, 30%; 75 years or older, 33%). Silent infarcts were small and subcortical. Independent risk factors were increasing age (odds ratio [OR], 1.95 per 25 years; confidence interval [CI], 1.19 to 3.15), hypertension (OR, 1.75; CI, 1.13 to 2.70), claudication (OR, 1.74; CI, 1.01 to 3.00), and male sex (OR, 1.72; CI, 1.12 to 2.64); other stroke risk factors such as atrial fibrillation and former transient ischemic attack were not independent risk factors. Patients with and without silent infarction did not differ in frequency of prestroke home care (P = .2). MMSE (P = .56), initial BI (P = .62) and SSS score (P = .08), BI (P = .85) and SSS score (P = .75) after completion of rehabilitation, or in the speed of recovery (P = .85). Length of hospital stay, mortality rate, and discharge rate to nursing home also did not differ between the two groups. This community-based study shows that silent infarction in stroke patients is more related to certain stroke risk factors than others and that silent infarction does not seem to influence the prognosis of stroke.

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Silent brain infarctions in patients with first-ever stroke. A community-based study in Umbria, Italy.

Cited by 66 publications

References 23 publications

An Updated Definition of Stroke for the 21st Century

An Updated Definition of Stroke for the 21st Century

Aspirin Attenuates the Incidence of Silent Brain Lesions in Patients With Nonvalvular Atrial Fibrillation

Silent infarction in acute stroke patients. Prevalence, localization, risk factors, and clinical significance: the Copenhagen Stroke Study.

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