Abstract
BackgroundCerebral infarction is a commonly observed radiological finding in the absence of corresponding, clinical symptomatology, the so-called silent brain infarction (SBI). SBIs are a relatively new consideration as improved imaging has facilitated recognition of their occurrence. However, the true incidence, prevalence and risk factors associated with SBI remain controversial.MethodsSystematic searches of the Medline and EMBASE databases from 1946 to December 2013 were performed to identify original studies of population-based adult cohorts derived from community surveys and routine health screening that reported the incidence and prevalence of magnetic resonance imaging (MRI)-determined SBI.ResultsThe prevalence of SBI ranges from 5% to 62% with most studies reported in the 10% to 20% range. Longitudinal studies suggest an annual incidence of between 2% and 4%. A strong association was seen to exist between epidemiological estimates of SBI and age of the population assessed. Hypertension, carotid stenosis, chronic kidney disease and metabolic syndrome all showed a strong association with SBI. Heart failure, coronary artery disease, hyperhomocysteinemia and obstructive sleep apnea are also likely of significance. However, any association between SBI and gender, ethnicity, tobacco or alcohol consumption, obesity, dyslipidemia, atrial fibrillation and diabetes mellitus remains unclear.ConclusionsSBI is a remarkably common phenomenon and endemic among older people. This systematic review supports the association of a number of traditional vascular risk factors, but also highlights disparities between clinically apparent and silent strokes, potentially suggesting important differences in pathophysiology and warranting further investigation.
Highlights
Cerebral infarction is a commonly observed radiological finding in the absence of corresponding, clinical symptomatology, the so-called silent brain infarction (SBI)
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant papers were identified by means of electronic searches of abstracts published in English in the Medline and EMBASE databases between 1946 to December 2013 using advanced search functions and the search terms: ‘silent brain infarcts’, ‘silent cerebral infarcts’, ‘silent stroke’ and ‘silent lacunar infarcts’; these were combined with the terms: ‘epidemiology’, ‘incidence’, ‘prevalence’ or ‘risk factors’ [see Additional file 1: Table S1: Detailed Search Strategies]
Incidence and prevalence of SBI Studies on the incidence and prevalence of SBI in population-based cohorts have primarily been conducted in two settings: representative community samples (CS) and participants undergoing routine health screening (RHS)
Summary
Cerebral infarction is a commonly observed radiological finding in the absence of corresponding, clinical symptomatology, the so-called silent brain infarction (SBI). Almost 50 years ago, Fisher [1] first described the presence of cerebral infarction in the absence of any clinically apparent stroke or transient ischemic attack It is only in recent years with major advances in imaging technology, that ‘silent’ brain infarcts (SBI) have been studied in any detail. These lesions are not benign, as originally thought, and associations with subtle neurological deficits [2,3], cognitive dysfunction [4,5,6], psychiatric disorders [2,7,8,9], clinically apparent stroke [10,11,12,13] and early mortality [4,10] have led to suggestions that the term ‘silent’ be replaced by ‘covert’ [14]. Of the epidemiological literature available on SBI, the most credible and generalizable data come from large population-based cohort studies (for example, community samples and routine health screens)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
