Silent Brain Infarction and Subcortical White Matter Lesions Increase the Risk of Stroke and Mortality: A Prospective Cohort Study

doi:10.1016/j.jstrokecerebrovasdis.2005.11.001

Journal of Stroke and Cerebrovascular Diseases

Volume 15, Issue 2, March–April 2006, Pages 57-63

https://doi.org/10.1016/j.jstrokecerebrovasdis.2005.11.001 Get rights and content

Silent brain infarction (SBI) and white matter lesions (periventricular hyperintensity [PVH] and subcortical white matter lesions [SWML] are detected in both stroke patients and normal elderly persons. We prospectively examined the association between these lesions and the risk of subsequent stroke and mortality in neurologically normal adults. Magnetic resonance imaging scans were performed in 2,684 neurologically normal subjects with no history of stroke (mean age, 58 ± 7 years old at entry) who underwent our health screening of the brain. After the brain screening, we obtained information about clinical stroke onset and death using a questionnaire sent annually to all subjects. When a subject suffered from medical events, we confirmed the detailed information in a telephone interview and by asking the attending physician. SBI was defined as a focal T2-hyperintensity and T1-hypointensity lesion > 3 mm. PVH and SWML were graded according to their severity. The average follow-up period was 6.3 years. Stroke occurred in 102 subjects (3.8%), and 93 subjects died during follow-up. The incidence of clinical stroke was significantly higher in the subjects with SBI than in those without SBI. Marked PVH and marked SWML independently increased the risk of stroke (for SBI, stroke risk factor–adjusted odds ratio [OR] = 3.66, 95% confidence interval [CI] = 2.28–5.89; for marked PVH, stroke risk factor–adjusted OR = 2.08, 95% CI = 1.04–4.17; for marked SWML, stroke risk factor–adjusted OR = 2.73, 95% CI = 1.32–5.63). Regarding mortality, SBI and marked PVH increased the risk of death (for SBI, stroke risk factor–adjusted OR = 1.95, 95% CI = 1.16–3.29; for PVH, stroke risk factor–adjusted OR = 4.01, 95% CI = 1.91–8.45). Death attributable to stroke occurred more frequently in those subjects with SBI, marked PVH, and marked SWML. We conclude that SBI, marked PVH, and marked SWML are important risk factors for clinical stroke and that SBI and marked PVH also increase the risk of mortality.

Section snippets

Subjects

We selected 3003 neurologically normal subjects with no history of stroke from participants who underwent our health screening of the brain between 1988 and 2003. All of the subjects voluntarily underwent the brain checkup in the interest of their own health. After the initial health screening, we obtained information about their medical events, specifically stroke and cardiovascular disease, by sending a questionnaire annually to each subject. We started this mailing in December 1992; by the

Prevalence of SBI, Marked PVH, and Marked SWML

SBI was found in 380 of the 2684 subjects (14.2%). The subjects with SBI (SBI group) were significantly older than those without SBI (no-SBI group) (62.0 ± 7.2 vs. 57.1 ± 7.0 years, respectively; P < .0001). The prevalences of grades 0–4 PVH were 43.9%, 35.1%, 17.7%, 3.1%, and 0.15%, respectively. Grade 1–3 SWML were observed in 10.7%, 2.8%, and 0.4% of the subjects, respectively. Figure 1 shows the prevalence of each lesion as a function of age. All of the lesions increased significantly with

Discussion

The prevalence of SBI in this study was 14.2%. This incidence rate is higher than in our previous study (10.6%)⁵ and is about half the value reported in the Rotterdam Scan Study.⁸ SBIs were usually found in the basal ganglia or deep white matter and were approximately 3–10 mm in diameter; therefore, most of the SBIs were considered lacunes. The Japanese community has a higher incidence of lacunes.14, 15 The prevalence of SBI varies among communities and is dependent on the age of the subjects

Acknowledgments

We thank Rieko Sakane and Fumi Asazu for assisting with the health screening of the brain, Kumi Katayama for assisting with the health screening of the brain and data management, and Mitsuyoshi Murao and Yuichi Aoyama for performing the MRI scanning.

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Citation Excerpt :
The main reason might be the small sample size in the present study. There have been some reports stating that WMH and lacunar infarcts might be associated with stroke.24,25 Bokura and colleagues24 suggested that WMH and silent lacunar infarcts can be important stroke risk factors and might be associated with increased mortality rates.
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: Supported by the Japan Science and Technology Agency (2002–2003) and Shimane Institute of Health Science (2003–2004)

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Original articleSilent Brain Infarction and Subcortical White Matter Lesions Increase the Risk of Stroke and Mortality: A Prospective Cohort Study

Section snippets

Subjects

Prevalence of SBI, Marked PVH, and Marked SWML

Discussion

Acknowledgments

J Am Coll Cardiol

Incidence, manifestations, and predictors of brain infarcts defined by serial cranial magnetic resonance imaging in the elderlythe Cardiovascular Health Study

Stroke

Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study

Stroke

Silent cerebral infarction in a community-based autopsy series in Japanthe Hisayama Study

Stroke

Incidence of silent lacunar lesion in normal adults and its relation to cerebral blood flow and risk factors

Stroke

Subcortical silent brain infarction as a risk factor for clinical stroke

Stroke

Silent MRI infarcts and the risk of future strokethe Cardiovascular Health Study

Neurology

Silent brain infarcts and white matter lesions increase stroke risk in the general populationthe Rotterdam Scan Study

Stroke

Silent brain infarcts and the risk of dementia and cognitive decline

N Engl J Med

An autopsy study of the incidence of lacunes in relation to age, hypertension, and arteriosclerosis

Stroke

Distinguishing silent lacunar infarction from enlarged Virchow-Robin spacesa magnetic resonance imaging and pathological study

J Neurol

White matter signal abnormalities in normal individualscorrelation with carotid ultrasonography, cerebral blood flow measurements, and cerebrovascular risk factors

Stroke

Magnetic resonance imaging signal hyperintensities in the deep and subcortical white mattera comparative study between stroke patients and normal volunteers

Arch Neurol

Original article
Silent Brain Infarction and Subcortical White Matter Lesions Increase the Risk of Stroke and Mortality: A Prospective Cohort Study