Silent brain infarcts in 755 consecutive patients with a first-ever supratentorial ischemic stroke. Relationship with index-stroke subtype, vascular risk factors, and mortality.

Abstract

Background and PurposeWe wanted to establish independent associations of various clinical variables, computed tomographic (CT) scan features, presenting stroke subtypes, and outcome with the presence of silent infarcts on CT.Methods We studied 755 consecutive patients in a prospective registration of patients with first-ever supratentorial atherothrombotic, cardioembolic, or lacunar stroke or stroke of undetermined cause by multiple logistic regression analysis.Results Two hundred six patients (27%) with a first symptomatic territorial or small deep ischemic stroke had one or more silent infarcts on CT. Of all silent lesions, 169 (82%) were small and deep. Silent infarcts were significantly more strongly associated with a lacunar than atherothrombotic (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.02 to 2.47; P=.O39) or cardioembolic (OR, 1.89; 95% CI, 1.2 to 2.99; P=.OO5) index stroke. Silent territorial lesions were more strongly associated with cardioembolic than with lacunar stroke but not with atherothrombotic stroke. In this respect, no differences were found between the atherothrombotic and undetermined-cause group. Advanced age and hypertension were the only risk factors that were significantly associated with silent infarcts (OR, 1.76; 95% CI, 1.14 to 2.71; P=.0U; and OR, 1.58; 95% CI, 1.13 to 2.21; P=.001; respectively), mainly because of a strong independent association of these risk factors with silent small deep infarcts (OR, 1.75; 95% CI,

Population-Based Case–Control Study of White Matter Changes on Brain Imaging in Transient Ischemic Attack and Ischemic Stroke

“…The association between lacunar infarcts and WMC has been documented by cross-sectional clinical, radiological (CT and MRI), and pathological studies. 15,16,34 Moreover, progression of WMC on follow-up has also been shown to be associated with previous lacunar infarction, 35,36 accepting that up to one third of lacunar infarcts diagnosed may be because of large vessel disease. 37 However, only a few conflicting studies [17][18][19][20] have compared the relationship between WMC and different pathogenic stroke subtypes, and there have been no previous case-control studies with sufficient power to stratify analyses by subtype.…”

Effects of Magnesium Treatment in a Model of Internal Capsule Lesion in Spontaneously Hypertensive Rats

“…[11][12][13] Hypertension represents the most important modifiable risk factor for stroke, including lacunar infarction. 14 In light of the Intravenous Magnesium Efficacy in Stroke trial subgroup analysis demonstrating treatment benefit in patients with higher-than-average BP, the aim of this study was to induce ischemia in the IC of the spontaneously hypertensive rat (SHR) to study the effects of MgSO 4 on lesion size and sensorimotor deficit.…”

Incidental Acute Infarcts Identified on Diffusion-Weighted Images: A University Hospital-Based Study: Fig 1.

“…5 These predisposing factors are also found in patients with lacunar infarcts; thus, it has been proposed that leukoaraiosis and symptomatic lacunar infarcts share a similar underlying vasculopathy, namely, subcortical occlusive small-vessel disease secondary to arteriolosclerosis. [7][8][9] Population studies have noted that leukoaraiosis progresses over a period of years. 6,10 The mechanism by which these lesions increase over time remains unknown.…”