The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size
- PMID: 23644857
- PMCID: PMC3611757
- DOI: 10.6061/clinics/2013(03)oa13
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.
Conflict of interest statement
No potential conflict of interest was reported.
Similar articles
-
Cognitive profile in patients with a first-ever lacunar infarct with and without silent lacunes: a comparative study.BMC Neurol. 2013 Dec 16;13:203. doi: 10.1186/1471-2377-13-203. BMC Neurol. 2013. PMID: 24341857 Free PMC article.
-
Contribution of arterial blood pressure to the clinical expression of lacunar infarction.Stroke. 1996 Mar;27(3):388-92. doi: 10.1161/01.str.27.3.388. Stroke. 1996. PMID: 8610300
-
Irregularly shaped lacunar infarction: risk factors and clinical significance.Arq Neuropsiquiatr. 2013 Oct;71(10):769-73. doi: 10.1590/0004-282X20130119. Arq Neuropsiquiatr. 2013. PMID: 24212512
-
Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: translation of knowledge to prevention strategies.Expert Rev Neurother. 2014 Mar;14(3):261-76. doi: 10.1586/14737175.2014.884926. Epub 2014 Feb 4. Expert Rev Neurother. 2014. PMID: 24490992 Review.
-
[Silent brain infarcts].Nervenarzt. 2011 Aug;82(8):1043-52. doi: 10.1007/s00115-011-3312-9. Nervenarzt. 2011. PMID: 21761183 Review. German.
Cited by
-
Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies.J Stroke. 2019 May;21(2):121-138. doi: 10.5853/jos.2018.03608. Epub 2019 Apr 17. J Stroke. 2019. PMID: 30991799 Free PMC article. Review.
-
Osteoporosis as an independent risk factor for silent brain infarction and white matter changes in men and women: the PRESENT project.Osteoporos Int. 2014 Oct;25(10):2465-9. doi: 10.1007/s00198-014-2785-3. Epub 2014 Jul 11. Osteoporos Int. 2014. PMID: 25011984
-
Basal Ganglia-Cortical Circuit Disruption in Subcortical Silent Lacunar Infarcts.Front Neurol. 2019 Jun 25;10:660. doi: 10.3389/fneur.2019.00660. eCollection 2019. Front Neurol. 2019. PMID: 31293502 Free PMC article.
-
Previous chronic cerebral infarction is predictive for new cerebral ischemia after carotid endarterectomy.J Cardiothorac Surg. 2015 Nov 2;10:141. doi: 10.1186/s13019-015-0367-x. J Cardiothorac Surg. 2015. PMID: 26525737 Free PMC article.
References
-
- Vermeer SE, Longstreth WT, Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6(7):611–9. - PubMed
-
- Moran C, Phan TG, Srikanth VK. Cerebral small vessel disease: a review of clinical, radiological, and histopathological phenotypes. Int J Stroke. 2012;7(1):36–46. - PubMed
-
- Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689–701. - PubMed
-
- Zhu YC, Dufouil C, Tzourio C, Chabriat H. Silent Brain Infarcts: A Review of MRI Diagnostic Criteria. Stroke. 2011;42(4):1140–5. - PubMed
-
- Boiten J, Lodder J, Kessels F. Two clinically distinct lacunar infarct entities. A hypothesis. Stroke. 1993;24(5):652–6. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources