Silent cerebral infarction in patients enrolled in the TOAST study

Ph, Davis; Wr, Clarke; Bh, Bendixen; Hp, Adams; Rf, Woolson; Culebras, Antonio

doi:10.1212/wnl.46.4.942

Cited by 50 publications

(34 citation statements)

References 11 publications

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“…Similar to previous studies (Boon et al 1994;Davis et al 1996;Kobayashi et al 1997), the present study also demonstrated that the presence of hypertension was a significant independent determinant of the severity of cerebral white matter lesions. However, the results of the present study were different from those of the previous LVDs, left ventricular end-systolic dimension; LV D d , l e f t v e n t r i c u l a r e n d -d i a s t o l i c dimension; LVMI, left ventricular mass index; LVEF, left ventricular ejection fraction; E, peak early diastolic transmitral flow; A, peak late diastolic transmitral flow; E/A, the ratio of E to A; E′, peak early diastolic mitral annular velocity; A′, peak late diastolic mitral annular velocity; E′/A′, the ratio of E′ to A′; E/E′, the ratio of E to E′.…”

Section: Discussionsupporting

confidence: 91%

“…It is now established that cerebral white matter lesions are associated with a high risk of stroke (Miyao et al 1992;van Swieten et al 1992). Numerous studies have demonstrated that age and hypertension are highly and independently correlated with white matter lesions, i.e., with periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH) (Boon et al 1994;Davis et al 1996;Kobayashi et al 1997). Kurata et al (2005) demonstrated that asymptomatic cerebral white matter lesions were related to carotid structure and hemodynamics, which have been demonstrated to be associated with the subsequent occurrence of stroke (Chambless et al 2000;Hollander et al 2002).…”

Section: Echocardiographic Examinationmentioning

confidence: 99%

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Cardiac Diastolic Dysfunction Is Associated with Cerebral White Matter Lesions in Elderly Patients with Risk Factors for Atherosclerosis

Masugata

Senda

Goda

et al. 2008

Tohoku J. Exp. Med.

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Cerebral white matter lesions on magnetic resonance imaging (MRI) are considered to be the result of brain ischemic injury and a risk factor for clinical stroke. The purpose of this study was to elucidate the relationship between the cardiac diastolic function and cerebral white matter lesions in elderly patients with risk factors for atherosclerosis. The study subjects were 55 patients (75 ± 7 years) with risk factors for atherosclerosis including hypertension, diabetes mellitus, and dyslipidemia. Patients with symptomatic cerebrovascular events were excluded from the study. Cerebral white matter lesions, which were defined as exhibiting high intensity regions on brain MRI, were evaluated with the degrees of periventricular hyperintensity (PVH) according to the Japanese Brain Dock Guidelines of 2003. Peak early diastolic mitral annular velocity (E′ velocity) was measured by tissue Doppler echocardiography, and was used as a parameter of cardiac diastolic function. The mean value of E′ velocity was decreased due to the cardiac diastolic dysfunction (5.2 ± 1.4 cm/s). In addition, the E′ velocity was inversely correlated with the degree of PVH (ρ = −0.701, p < 0.001). Stepwise regression analysis showed that the decrease in the E′ velocity (β coefficient = −0.42, p < 0.001) and the presence of hypertension (β coefficient = 0.31, p = 0.001) were independent determinants of the degree of PVH. Thus, cardiac diastolic dysfunction is correlated to the severity of cerebral white matter lesions, suggesting the cardio-cerebral connection in elderly patients with risk factors for atherosclerosis.Cardiac diastolic function; cerebral white matter lesions; echocardiography.Tohoku J. Exp. Med., 2008, 216 (2), 99-108.

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Section: Discussionsupporting

confidence: 91%

Section: Echocardiographic Examinationmentioning

confidence: 99%

Cardiac Diastolic Dysfunction Is Associated with Cerebral White Matter Lesions in Elderly Patients with Risk Factors for Atherosclerosis

Masugata

Senda

Goda

et al. 2008

Tohoku J. Exp. Med.

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“…The prevalence of silent lesions in previous CT or MRI studies varies from 10% to 47%, [6][7][8][9]23,24 and populationbased studies using MRI report a prevalence of silent lesions ranging from 11% to 28%. 2,25,26 In the present study, the prevalence of silent lesions by MRI, especially those ≥3 mm, was 44.9% in control patients, which is relatively high compared with previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] The reported prevalence of silent lesions observed by MRI varies, 3,[6][7][8][9] but there is consensus that it is high in elderly subjects and in patients with risk factors for stroke (eg, hypertension and atrial fibrillation (AF)). 1,4,10,11 The importance of these silent lesions has been emphasized in reports linking them to impaired cognition 2 and depression.…”

mentioning

confidence: 99%

Aspirin Attenuates the Incidence of Silent Brain Lesions in Patients With Nonvalvular Atrial Fibrillation

Sato

Koretsune

Fukunami³

et al. 2004

Circ J

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Background Abnormal findings, including silent cerebral infarction, are frequently observed by magnetic resonance imaging (MRI) in patients with nonvalvular atrial fibrillation (NVAF); however, the prevalence and prevention strategy for these lesions have not been extensively studied. In the present study the preventive effects of aspirin on silent ischemic lesions was investigated. Methods and Results Silent lesions were counted using cranial MRI performed in 78 neurologically normal adults with sinus rhythm and in 212 patients with NVAF without a history of stroke. MRIs were repeated twice in the NVAF patients at 12-month intervals. During the first year, patients received neither antiplatelet agent nor anticoagulant; in the second year, aspirin (330 mg daily) was administered. The prevalence of lesions in the initial MRI was higher in NVAF patients (86.4%) than in sinus rhythm subjects (53.8%; p<0.001). After 12 months without aspirin, new lesions were seen in 20.6% of NVAF patients. The yearly occurrence of new lesions was decreased to 9.6% during the year of treatment with aspirin (p=0.014). Conclusions In patients with NVAF, abnormal lesions are frequently observed by MRI and aspirin treatment may be effective in preventing further small silent lesions. (Circ J 2004; 68: 410 -416)

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“…The lesions are most frequently found in the basal ganglia 9 and periventricular white matter, which are not major areas that govern motor and sensory functions, but rather sites associated with coordination and the relay of signals through parts of the brain. However, the presence of cortical lesions and large lesions of Ͼ3 to 4 cm in diameter in subjects without noticeable neurological deficits still awaits elucidation.…”

Section: Lee Et Almentioning

confidence: 99%

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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Silent cerebral infarction in patients enrolled in the TOAST study

Cited by 50 publications

References 11 publications

Cardiac Diastolic Dysfunction Is Associated with Cerebral White Matter Lesions in Elderly Patients with Risk Factors for Atherosclerosis

Cardiac Diastolic Dysfunction Is Associated with Cerebral White Matter Lesions in Elderly Patients with Risk Factors for Atherosclerosis

Aspirin Attenuates the Incidence of Silent Brain Lesions in Patients With Nonvalvular Atrial Fibrillation

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

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