Abstract
Brain infarctions are closely associated with future risk of stroke and dementia. Our goal was to report (i) frequency and characteristics that differentiate symptomatic vs. silent brain infarctions (SBI) on MRI and (ii) frequency and location by vascular distribution (location of stroke by major vascular territories) in a population based sample. From Mayo Clinic Study of Aging, 347 participants (≥50 years) with infarcts detected on their first MRI were included. Infarct information was identified visually on a FLAIR MRI image and a vascular territory atlas was registered to the FLAIR image data in order to identify the arterial territory of infarction. We identified the subset with a clinical history of stroke based on medical chart review and used a logistic regression to evaluate the risk factors associated with greater probability of a symptomatic stroke vs. SBI. We found that 14% of all individuals with infarctions had a history of symptomatic stroke (Silent: n = 300, symptomatic: n = 47). Factors associated with a symptomatic vs. SBI were size which had an odds ratio of 3.07 (p < 0.001), greater frequency of hypertension (odds ratio of 4.12, p = 0.025) and alcohol history (odds ratio of 4.58, p = 0.012). The frequency of infarcts was greater in right hemisphere compared to the left for SBI. This was primarily driven by middle cerebral artery (MCA) infarcts (right = 60%, left = 40%, p = 0.005). While left hemisphere strokes are more common for symptomatic carotid disease and in clinical trials, right hemispheric infarcts may be more frequent in the SBI group.
Highlights
Brain infarcts are a common cerebrovascular pathology of aging and a common cause of cognitive impairment [1]
When we ran a multivariate logistic regression model with all risk factors, we found only size of the infarction (OR = 3.07, p < 0.001), hypertension (OR = 4.12, p = 0.025), and alcoholism (OR = 4.58, p = 0.012) significantly predicted symptomatic stroke vs. silent brain infarctions (SBI) (Table 2)
We report on the frequency, location, and characteristics of clinical vs. silent brain infarctions in a population based sample
Summary
Brain infarcts are a common cerebrovascular pathology of aging and a common cause of cognitive impairment [1]. The term “Silent brain infarcts” (SBI) [2,3,4,5], has been used to refer to infarcts which are observed on conventional MRI or CT but without known clinical symptoms. SBI make up the majority of infarcts in population-based studies [6,7,8] compared to clinically recognized infarcts. SBI have become an established risk factor for future symptomatic infarcts and cognitive decline. While stroke trials have revealed a greater likelihood of left cerebral hemispheric (LH) infarctions compared to right hemispheric (RH) infarctions [11, 12], the topography of SBI has been understudied. Our objective was to report on the frequency and characteristics that differentiate symptomatic vs SBI on MRI and explore their frequency and location by major vascular
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