Risk Factors for Silent Cerebral Infarcts in Subcortical White Matter and Basal Ganglia

Abstract

Background and Purpose-The purpose of this study was to clarify whether the relevant risk factors for silent cerebral infarcts (SCIs) in subcortical white matter (WM) are different from those in the basal ganglia (BG). Methods-Subjects of this study were 219 adults without a history of stroke or transient ischemic attack and without any abnormality on a neurological examination who consecutively visited the neurology service in our hospital between January 1994 and November 1997 requesting medical evaluation for possible cerebrovascular diseases. Subjects included 141 men and 78 women ranging in age from 33 to 83 years (meanϮSD, 63.2Ϯ9.5 years). We performed brain MRIs and cervical/cranial MR angiographies on all subjects. In this study, SCI was defined as a focal lesion Ͼ5 mm in diameter that was prolonged on both T2-weighted and proton density images. Results-SCIs in the WM and/or BG were detected in 88 (40.2%) of the 219 subjects. No SCI Ͼ15 mm was observed in this series. Fifty of the subjects had SCIs only in the WM, 32 subjects had SCIs in both the WM and BG, and 6 subjects had SCIs only in the BG. Thus, 82 (93.2%) of 88 subjects with SCIs had lesions in the WM. Most subjects with SCIs in the BG also had SCIs in the WM. Multiple logistic regression analyses revealed that age, female sex, and hypertension were significant and independent predictors of SCIs in the WM, and that age, a history of ischemic heart disease, and carotid artery stenosis were significant and independent predictors of SCIs in the BG. Conclusions-The present study indicated that the relevant risk factors for SCIs in the WM and those for SCI in the BG were different. Our results suggest that SCIs are prone to first appear in the WM in association with aging and hypertension, and the additional appearance of SCIs in the BG predicts a progression of generalized atherosclerosis that is manifested in the carotid and coronary arteries. (Stroke. 1999;30:378-382.)

Low-Density Lipoprotein Subfractions and the Prevalence of Silent Lacunar Infarction in Subjects with Essential Hypertension

“…The pathogenesis of SLI has been considered to differ between the white matter infarction and the basal ganglia infarction. Recent studies have shown that the relative risk factors are different between the white matter infarction and the basal ganglia infarction (18). Thus high blood pressure was a predominant risk factor for white matter infarction, but basal ganglia infarction was associated with systemic atheroscleroses such as coronary artery disease and carotid artery stenosis.…”

Silent cerebral microbleeds associated with arterial stiffness in an apparently healthy subject

“…Lacunar infarcts were defined as areas of low signal intensity (3-to 15-mm diameter) on T1-weighted images and of high intensity on T2-weighted and FLAIR images. PVHs were defined as white matter hyperintensities depicted on T2-weighted and FLAIR images 15,16 in contact with the ventricular wall. PVH was further classified into five grades according to the Japanese Braindock Guidelines 2003, 17 namely grade 0, absent or only a 'rim'; grade 1, limited lesion-like 'caps'; grade 2, irregular 'halo'; grade 3, irregular margins and extension into the deep white matter; and grade 4, extension into the deep white matter and subcortical portion.…”

Association between Carotid Hemodynamics and Asymptomatic White and Gray Matter Lesions in Patients with Essential Hypertension

“…The MRI findings were classified according to the following parameters: PVH, DSWMH, and état criblé, according to the Japanese Braindock Guidelines 2003 (15). PVH and DSWMH were defined as exhibiting high intensity lesions by T2-weighted and proton density images or by fluid-attenuated inversion recovery (FLAIR) (16,17), and low intensity determined by T1-weighted images. État criblé was assessed at the basal ganglial level, as high-intensity signals evaluated by T2-weighted images (18).…”