Silent brain infarcts in patients with manifest vascular disease

• Published in: Stroke (1970) 2004-03, Vol.35 (3), p.742-746
• Main Authors: GIELE, Janneke L. P, WITKAMP, Theo D, MALI, Willem P. T. M, VAN DER GRAAF, Yolanda
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - epidemiology; Biological and medical sciences; Brain Infarction - diagnosis; Brain Infarction - epidemiology; Cohort Studies; Comorbidity; Female; Humans; Hyperhomocysteinemia - epidemiology; Hypertension - epidemiology; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nervous system; Netherlands - epidemiology; Neurology; Neuropharmacology; Neuroprotective agent; Odds Ratio; Pharmacology. Drug treatments; Prevalence; Prospective Studies; Renal Insufficiency - epidemiology; Risk Factors; Ultrasonic investigative techniques; Vascular Diseases - epidemiology; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000117572.56058.2A

Silent infarcts are frequently found on MRIs of brains of healthy elderly persons (aged >60 years). The purpose of this study was to investigate the prevalence and determinants of silent infarcts in a population of patients with clinically manifest vascular disease. To detect silent infarcts, MR images were made in 308 participants of the Second Manifestations of ARTerial disease (SMART) study (mean age, 58 years) without prior stroke or transient ischemic attack. These are patients referred to the University Medical Center Utrecht because of atherosclerotic vascular disease. Risk factors were assessed by questionnaire and by physical, ultrasonographic, and laboratory examinations. Silent infarcts were found in 51 patients (17%). Most infarcts (62%) were located in white matter, 20% in basal ganglia, 14% in brain stem and cerebellum, and 4% in cortical area. Categorical determinants for presence of silent infarct(s) that remained (borderline) significant after adjustment for age were hypertension (odds ratio [OR]=2.2; 95% CI, 1.2 to 4.2), abdominal aortic aneurysm (OR=2.4; 95% CI, 0.9 to 6.4), severe renal failure (OR=7.3; 95% CI, 2.1 to 25.2), and hyperhomocysteinemia (OR=2.6; 95% CI, 1.1 to 5.9). Patients with manifest vascular disease are at risk for silent infarcts at a younger age. In particular, patients with the aforementioned risk factors should be considered for treatment or (secondary) prevention.