The silent brain infarct in carotid surgery

333

191

As part of a prospective therapy study of 65 patients with acute, nonhemorrhagic, cerebral infarction, computed tomographic scans of the head were obtained at admission, 7-10 days, and 3 months. The scans were analyzed for the presence, site, size, and volume measurement of the infarction. At 7-10 days, the mean infarction volume as measured by computed tomography was 55 cm 3 or about 4x4x3.5 cm (range=0-507 cm 3 ). At 3 months, the mean infarction volume decreased by 25% to 41 cm

Section: Discussionmentioning

confidence: 99%

Measurements of acute cerebral infarction: lesion size by computed tomography.

Brott

Marler

Olinger

et al. 1989

333

191

“…Also, approximately 20% of patients with asymptomatic carotid stenosis have infarcts confirmed on CT scan, 3 while multiple small infarcts without any accompanying symptoms sometimes appear after carotid endarterectomy. 4 Because stroke is a clinical phenomenon, these asymptomatic lesions are better termed "silent infarctions" than "silent strokes. "…”

Section: S Oon After the Advent Of Computed Tomography Itmentioning

confidence: 99%

“…3 Similarly, the 6% incidence of silent infarcts after carotid surgery might be regarded as perioperative complications in the same light as minor strokes. 4 We see no justification in devising a new terminology to incorporate the results of CT scanning in established clinical terms such as TIAs or resolving ischemic neurological deficit, even if there is evidence that these findings confer a less favorable prognosis. 5 The clinical spectrum from asymptomatic patients, through TIAs to stroke, is a distinct and separate dimension which intersects that of laboratory investigations such as CT scanning.…”

mentioning

confidence: 99%

Silent stroke and carotid stenosis.

Norris

Zhu

1992

123

Background and Purpose: Silent cerebral infarction is often found on computed tomographic scan in patients with asymptomatic carotid stenosis, but its relation to the arterial stenosis is uncertain.Methods: We compared computed tomographic scans and carotid Doppler in 115 patients with asymptomatic carotid stenosis, 203 with carotid transient ischemic attacks and carotid stenosis, and 63 with transient ischemic attacks but without carotid stenosis. There was no group with normal carotid arteries for comparison.Results: Lesions seen on CT scan were most common in the transient ischemic attack with carotid stenosis group (47%) compared with the other groups (30%, 19%) (p<0.001). Cerebral infarcts ipsilateral to the carotid stenosis were found in 10% of patients with mild (35-50%) stenosis, 17% in moderate (50-75%) stenosis, and 30% with severe (>75%) carotid stenosis (p<0.001). In patients with asymptomatic carotid stenosis, 68% of infarcts were ipsilateral to the stenosis; in those with transient ischemic attacks and carotid stenosis, 86% of infarcts were ipsilateral to the stenosis.Conclusions: The more severe the carotid stenosis, the higher the incidence of cerebral infarction ipsilateral to the stenosis. This finding applied to central infarcts as well as to peripheral infarcts in both symptomatic and asymptomatic patients. Silent cerebral infarction may be an indication for carotid endarterectomy in asymptomatic patients.

“…12 In other studies,3-10 patients were not always representative of all stroke patients because these studies were performed in selected populations: patients with transient ischemic attacks (TIA) or minor strokes and free of atrial fibrillation3; patients with nonvalvular atrial fibrillation4-6; and patients with carotid stenosis.7-10 These studies revealed that atrial fibrillation4-6 and carotid stenosis were predisposing factors for silent infarct.7-10 To our knowledge, system-atic echocardiography in consecutive patients who were not selected on the basis of a potential cause of stroke has never been used in studies on silent infarct. [1][2][3][4][5][6][7][8][9][10] The aim of our study was to determine, among consecutive patients with stroke or TIA, whether the presence of silent infarct is related to the various vascular risk factors for the presumed mechanism of stroke. Magnetic resonance imaging frequently detects silent lesions," but some are of nonvascular origin12; for this reason we performed this study by means of CT scan.…”

mentioning

confidence: 99%

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

Mounier‐Véhier

Leys

Rondepierre

et al. 1993

Background and Purpose: Possible specific risk factors for silent infarcts remain unknown. The aim of this study was to investigate whether risk factors for silent infarcts differ from those for symptomatic infarcts in stroke patients.Methods: Silent infarcts were defined as asymptomatic infarcts detected on computed tomographic scan in patients free of history of stroke and unrelated to the symptoms and signs of the index stroke. Of 595 consecutive patients with stroke or transient ischemic attacks, 116 (19%) had at least one silent infarct on the first computed tomographic scan performed within 24 hours after onset. They were compared with the 479 remaining patients for cerebrovascular risk factors and for presumed mechanism of stroke by means of the odds ratio method. A discriminant analysis was then performed in the subgroup of 216 patients with ischemic stroke who underwent an exhaustive cardiac and vascular workup.Results: One hundred forty-one silent infarcts (99% confidence interval [CI], 29o to 41%) and 265 symptomatic infarcts (99o CI, 59% to 71%) were subcortical infarcts smaller than 15 mm. Univariate