The growing specter of MRI-defined brain infarcts

Abstract

The devastating effects of stroke have been recognized since antiquity. As the name stroke implies, this clinical event is characterized by the sudden onset of neurologic deficits related to vascular disease. An initial hint that vascular disease of the brain was far more pervasive than suggested by the occurrence of strokes due to overt brain infarcts came from pathologic studies showing that small subcortical brain infarcts were common in elderly patients who had no history of a stroke.1 With the advent of sophisticated brain imaging, especially MRI, the frequency of brain infarcts could be quantified initially in groups of select patients and eventually in populations of healthy people. These brain infarcts are common and, although often labeled benign and silent, have been associated with an increased risk of subsequent cognitive impairment, dementia, and stroke.2–6 The descriptor covert was suggested to convey the potentially ominous clinical course in patients harboring these MRI-defined brain …