Implications of silent strokes.pdfVIP

Implications of Silent Strokes Frank M. Yatsu, MD, and Hashem M. Shaltoni, MD Address The University of Texas at Houston Medical School, 6431 Fannin, MSB 7.044, Houston, TX 77030, USA. E-mail: Frank.M.Yatsu@uth.tmc.edu Current Atherosclerosis Reports 2004, 6:307–313 Current Science Inc. ISSN 1523-3804 Copyright ? 2004 by Current Science Inc. Introduction As the term “silent strokes” indicates, patients may have sin- gle or multiple strokes that are either ischemic infarcts or hemorrhages that produce no significant neurologic symp- toms or signs or are either asymptomatic or trivial in nature. They are found incidentally while getting a brain imaging study (eg, computerized tomography [CT] or magnetic reso- nance imaging [MRI] including diffusion-weighted imaging [DWI]) [1] for a stroke or other neurologic work-up. Prior to the advent of neuroimaging techniques, silent strokes were discovered at autopsy; however, because an accurate history could not be taken to verify the truly “silent” natures of these strokes, it was not until the widespread use of neuroimaging that the nature, extent, risks, and prognostic features of silent strokes could be appreciated and investigated. As pointed out by Masuda et al. [2], silent stroke, silent cerebrovascular lesion, or what others called “covert stroke” became com- mon terminology in the recent literature, and because of its prognostic implications it has led to a number of epidemio- logic, pathogenetic, genetic, clinical, and population-based studies (Fig. 1). This article reviews the literature, particularly on the nature and extent of silent strokes, but also emphasizes for clinicians the importance of recognizing that silent strokes are more frequent with certain predisposing disorders, such as atrial fibrillation, and, therefore, require a higher degree of vigilance and awareness [3]. Finally, the impor- tance of appreciating their prognostic significance is emphasized. Because these silent strokes are associated with a