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Frequency and pathogenesis of silent subcortical brain infarction in acute first-ever ischemic stroke

Tomohide Adachi1, Shotai Kobayashi, Shuhei Yamaguchi

  • 1Department of Internal Medicine III, Shimane Medical University, Izumo.

Internal Medicine (Tokyo, Japan)
|March 1, 2002
PubMed
Abstract

Insights

Silent subcortical brain lesions are more common in lacunar infarction than other stroke types. These lesions are linked to small-vessel vasculopathy, the likely cause of lacunar infarction.

Area of Science:

  • Neurology
  • Radiology
  • Cerebrovascular Disease

Background:

  • Silent subcortical brain lesions are frequently observed in ischemic stroke patients.
  • Limited data exists on the association between these lesions and specific stroke subtypes.
  • Understanding this relationship is crucial for stroke subtyping and pathogenesis research.

Purpose of the Study:

  • To determine the incidence of MRI-detected silent subcortical brain lesions in first-ever ischemic stroke patients.
  • To analyze the relationship between these lesions and stroke subtypes (lacunar, atherothrombotic, cardioembolic).
  • To discuss the potential pathogenesis of silent subcortical lesions.

Main Methods:

  • 171 patients with acute first-ever ischemic stroke were evaluated.
  • Patients were classified into lacunar, atherothrombotic, and cardioembolic infarction groups.
  • MRI was used to assess silent subcortical brain infarction (SSBI), enlarged perivascular spaces (EPS), and white matter lesions.

Main Results:

  • Silent subcortical brain infarction (SSBI) was significantly more frequent in lacunar infarction (81.5%) compared to atherothrombotic (44.4%) and cardioembolic (42.1%) groups.
  • High-grade enlarged perivascular spaces (EPS) (grade 2+) were also more prevalent in lacunar infarction (63.3%) versus atherothrombotic (24.2%) and cardioembolic (0%) groups.
  • Scheltens' score for silent subcortical lesions was notably higher in the lacunar infarction group.

Conclusions:

  • Silent subcortical ischemic brain lesions occur more frequently in lacunar infarction than in atherosclerotic or cardioembolic infarction.
  • The findings suggest a common pathogenesis for silent subcortical lesions and lacunar infarction, likely related to small-vessel vasculopathy.
  • This highlights the importance of small-vessel disease in the development of silent subcortical lesions in stroke patients.

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