The 'silence’ of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size

Abstract

OBJECTIVE:Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their ‘silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this ‘silence'.METHODS:In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times.RESULTS:The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups.CONCLUSIONS:Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the ‘silence' of silent brain infarctions.

Flow diversion treatment of complex bifurcation aneurysms beyond the circle of Willis: a single-center series with special emphasis on covered cortical branches and perforating arteries

“…It is known that silent brain infarcts are often lacunar lesions of perforating arteries,19 and the fact that they do not necessarily evoke clinical symptoms is probably attributable to non-strategic localizations 20. This is in contrast to the posterior circulation where higher rates of clinically apparent perforator strokes are reported; for example, in a series by Kulcsár et al ,21 delayed symptomatic ischemic events related to perforating artery occlusion were seen in 3/12 patients with basilar artery aneurysms treated with the SILK FD.…”

Silent Brain Infarcts in Patients with Non-Specific Neurological Symptoms: 1-Year Cross-Sectional Study

“…The most commonly observed nonspecific neurological symptom in the present study were headache (54.90%), dizziness (23.53%), and vertigo (25.49%). Studies reporting the risk factors for SBI have always implicated hypertension, age, and BMI (1,2,7) . In the present study, HDL, triglyceride, and hsCRP levels are the major risk factors for development of SBIs in the patients along with BMI and high blood pressure unlike factors such as smoking and alcohol consumption.…”

“…The asymptomatic nature of SBIs can be attributable to long-term ischemic tolerance and chronic ischemic pre conditioning (1) . However, it can be identified only with the help of different www.jmscr.igmpublication.…”

“…However, it can be identified only with the help of different www.jmscr.igmpublication. (1,2) . SBIs has been associated with an increased risk of cognitive decline and stroke (3) .…”

“…Silent brain infarctions (SBIs) are the asymptomatic parenchymal lesions believed to be caused by occlusion of the small blood vessels (1,2) . The asymptomatic nature of SBIs can be attributable to long-term ischemic tolerance and chronic ischemic pre conditioning (1) .…”