Silent infarcts in patients with ischemic stroke are related to age and size of the left atrium.

Mounier‐Véhier, F.; Leys, D.; Rondepierre, Ph.; Godefroy, Olivier; Pruvo, Jean‐Pierre

doi:10.1161/01.str.24.9.1347

Cited by 53 publications

(50 citation statements)

References 28 publications

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“…Age was the most consistent risk factor, 7-10 and other risk factors included hypertension, 5,10 male gender, 5,9,10 glucose intolerance, 4 ischemic changes on ECG, 5 and left atrial enlargement. 8 In our study, independent risk factors of SCI were an increase in age and a history of hypertension, which are in accord with most of the previously described small-scale studies. A history of coronary artery disease, cardiomegaly on chest radiographs, and high levels of blood hemoglobin A1c and fasting plasma glucose may summon a certain interest as being potential risk factors for SCI, because those characteristics were identified as risk factors on univariate analysis.…”

Section: Lee Et Alsupporting

confidence: 91%

Prevalence and Risk Factors of Silent Cerebral Infarction in Apparently Normal Adults

et al. 2000

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Abstract-Cerebrovascular disease is a major cause of death and disability in adults. Silent cerebral infarction (SCI) portends more severe cerebral infarctions or may lead to insidious progressive brain damage resulting in vascular dementia. This study was designed to evaluate the prevalence and risk factors of SCI in an apparently normal adult population. Nine hundred ninety-four consecutive symptom-free adults (mean age 49.0Ϯ7.7; men:women 830:164) who underwent brain magnetic resonance imaging at the Center for Health Promotion at Samsung Medical Center were assessed. All were neurologically normal in history and physical examination. A total of 121 SCI lesions was observed in 58 subjects. The lesion prevalence adjusted for patient age was 5.1%. There was no gender difference in prevalence. Ninety-nine lesions were Ͻ1 cm in diameter, 15 were between 1 and 2 cm, 3 were between 2 and 3 cm, and 4 were Ͼ3 cm in diameter. The most frequent site of the SCI lesion was basal ganglia, after which the periventricular white matter, cerebral cortex, and thalamus were the most frequent sites. Old age, hypertension, a history of coronary artery disease, evidence of cardiomegaly in chest radiographs, and high fasting glucose/hemoglobin A1c levels were associated with SCI on univariate analysis. Multivariate analysis demonstrated old age and hypertension to be independent risk factors for SCI, and mild alcohol consumption was revealed as an independent protective factor against SCI. Key Words: cerebral infarction Ⅲ risk factors Ⅲ hypertension, essential Ⅲ elderly Ⅲ alcohol S ilent cerebral infarction (SCI) is defined as a brain lesion that is presumably a result of vascular occlusion found incidentally by magnetic resonance imaging (MRI) or computed tomography (CT) in otherwise healthy subjects or during autopsy. [1][2][3] It is considered a precursor of symptomatic stroke and progressive brain damage 1-3 that may be associated with vascular dementia.The reported prevalence of SCI has been varied, depending on the study subjects. In studies dealing with symptomatic stroke patients, that prevalence ranged from 10% to 38%. 4,5 A prevalence of 13% was reported in a small population study of normal subjects, 6 and in a study on a large number of elderly subjects, the prevalence was 33% in patients Ն65 years. 7 Because such variance in study subjects has led to different conclusions in regard to the prevalence and risk factors of SCI, 8 -10 we attempted to present a more comprehensive study of SCI in a relatively large population of apparently normal adults of all ages. Methods SubjectsWe studied 994 healthy consecutive subjects who visited the Center for Health Promotion at Samsung Medical Center, Seoul, Korea, from September 1994 through October 1996 and who underwent MRI of the brain as part of their routine health check. Their age ranged from 20 to 78 years; 54 subjects were Ͻ40 years, 572 subjects were between 40 and 49 years, 271 subjects were between 50 and 59 years, 81 subjects were between 60 and 69 years, and 16 subj...

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Section: Lee Et Alsupporting

confidence: 91%

Prevalence and Risk Factors of Silent Cerebral Infarction in Apparently Normal Adults

et al. 2000

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“…# AF. "Defined according to the criteria of Mounier-Vehier et al 24 Patients with large-vessel atherosclerosis had a narrowing of the lumen of the ICA of >50%. Patients 13 and 14 had a narrowing of the lumen of the ICA of 15% and 25%.…”

Section: Methodsmentioning

confidence: 99%

“…4 We defined a basal ganglia small infarct as any infarct less than 15 mm involving the basal ganglia and sparing the cortical surface; we used Bogousslavsky's criteria to define centrum ovale, 21 watershed, 22 and internal junctional 23 infarcts. We defined silent infarcts according to the criteria of MounierVehier et al 24 …”

Section: Methodsmentioning

confidence: 99%

Anterior choroidal artery territory infarcts. Study of presumed mechanisms.

Leys

Mounier‐Véhier

Lavenu

et al. 1994

Stroke

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A previous study suggested that occlusive diseases of small penetrating arteries account for most anterior choroidal artery (AChA) territory infarcts, but half of the patients did not have an echocardiogram. Cases of AChA territory infarcts associated with internal carotid artery stenosis or atrial fibrillation suggest that this hypothesis may be wrong. The aim of this study was to determine the mechanism of 16 nonselected consecutive AChA territory infarcts. The study population consisted of 8 men and 8 women aged 17 to 89 years. They underwent a computed tomographic scan at the acute stage, Doppler ultrasonography and B-mode echotomography of the cervical arteries, bidimensional transthoracic echocardiography, and cerebral magnetic resonance imaging, replaced by a second computed tomographic scan in 3 patients. Ten patients underwent cerebral angiography. We defined the presumed cause of stroke according to the criteria used in the trial of Org 10172 in acute stroke treatment. The presumed cause of stroke was definite cardio-embolism in 4 patients (atrial fibrillation in 2, paradoxical embolism in 1, and left ventricular akinesia in 1); definite large-vessel atherosclerosis in 2; dissection of the internal carotid artery in 2; and definite small-vessel occlusion in 1. Seven patients had a negative diagnostic workup. Six patients had no risk factors for small-vessel occlusion. The AChA was not visible on angiography in 4 patients. One patient had two arterial cutoffs, suggestive of emboli in other cerebral arteries. This study suggests that AChA territory infarcts are rarely related to small-vessel occlusion and therefore require a complete diagnostic workup.

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“…13 -6 -7 However, these studies can be criticized for several reasons: two were rather small, 6 a cohort of only a certain age was included, 3 a subgroup was selected based only on whether certain ancillary investigations were performed, 7 patients with transient ischemic attack were included in a stroke series, 7 and multiple logistic regression analysis allowing for collinearity between factors associated with silent infarct was not performed. sis.…”

mentioning

confidence: 99%

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

Boon

Lodder

Raak

et al. 1994

Stroke

117

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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,

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Silent infarcts in patients with ischemic stroke are related to age and size of the left atrium.

Cited by 53 publications

References 28 publications

Prevalence and Risk Factors of Silent Cerebral Infarction in Apparently Normal Adults

Prevalence and Risk Factors of Silent Cerebral Infarction in Apparently Normal Adults

Anterior choroidal artery territory infarcts. Study of presumed mechanisms.

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

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