Infarctlike lesions in the brain: prevalence and anatomic characteristics at MR imaging of the elderly--data from the Cardiovascular Health Study.

Abstract

If the lesions reported in this study indicate cerebrovascular disease, subclinical disease may be more prevalent than clinical disease, and the prevalence of disease may rise with age. Also, infarctlike lesions have a distinctive anatomic profile.

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

“…That these associations were relatively weak and inconsistent, particularly after adjusting for IMT/stenosis, does not lend support for a direct pathogenic mechanism. Limiting analyses to large or watershed infarcts, which are more likely to be due to large-vessel atherosclerosis than to small-vessel hypertensive disease, 2,36 did not increase the strength of relationships with carotid plaque characteristics and thus also fails to support a direct pathogenic role for carotid disease. Conversely, the strong and consistent associations of small infarct-like lesions with plaque heterogeneity, especially given the lack of association of these lesions with carotid atherosclerosis severity and many other cardiovascular disease risk factors, raises questions about the pathogenesis of these mysterious lesions that may merit further investigation.…”

“…2 Given the strong and consistent relationships of MRI abnormalities to severity of carotid atherosclerosis, the question arises whether there are other ultrasound-definable characteristics of carotid disease that are related to MRI abnormalities. Clinical studies of carotid atherectomy specimens suggest that ulcerated, 20 less organized, 15 and hemorrhagic 21,22 plaques are associated with symptoms.…”

“…[1][2][3] While these findings are related to standard risk factors for cardiovascular disease and are believed to be consequences of ischemia, 4 -6 their relationship to atherosclerosis in the carotid arteries has not been widely explored.…”

“…Cross-sectional data from these examinations were analyzed (1) to describe prevalences of MRI-defined infarcts, infarctlike lesions, and gray and white matter changes by quintile of common and internal carotid intimal-medial thickness (IMT); degree of carotid stenosis; and characteristics of carotid plaque; (2) to determine independence of carotid atherosclerosis/MRI abnormality associations from known clinical and subclinical cardiovascular disease and cardiovascular disease risk factors; and (3) to define relationships of MRI infarcts and ipsilateral carotid artery disease. tion 4 US communities: Forsyth County, NC; Sacramento County, Calif; Washington County, Md; and Pittsburgh (Allegheny County), Pa.…”

Silent Cerebral Infarctions in Type II Diabetes Mellitus Patients; Could Brain MRI Be a Routine Investigation?

“…While numerous reports have documented the frequency of presumed infarctions on CT or MRI in persons with a history of (or at risk for) overt stroke [8]- [12], few studies have reported prevalence of such lesions in an asymptomatic community-dwelling population [13].…”