Share This Article:

Silent brain infarctions and leuko-araiosis in Chinese patients with first-ever acute lacunar strokes

Abstract Full-Text HTML Download Download as PDF (Size:678KB) PP. 443-447
DOI: 10.4236/jbise.2010.35061    4,013 Downloads   7,732 Views   Citations

ABSTRACT

We report on silent brain infarction (SBI) and leuko- araiosis (LA) of 23 patients with clinically diagnosed “first-ever” acute ischemic lacunar stroke. The lacunar syndromes were pure motor hemiparesis (10), pure sensory syndrome (2), ataxic hemiparesis (3), dysarthria clumsy hand syndrome (3), and sensory- motor deficit (5). Nineteen out of the 23 patients presented with completed strokes on arrival to the hospital, and 4 (17%) developed evolving-stroke within 24 hours of stroke onset. A lacune corresponded to the acute stroke could be found in all patients on brain magnetic resonance imaging (MRI), and in 18 (78%) on brain computed tomography (CT). MRI showed additional subclinical or asymptomatic “silent brain infarctions or lacunes” (SBI) in 19 (83%) of 23 patients, and leuko-araiosis (LA) of moderate to severe degree (> grade 2) was present in 61% of patients although dementia was absent. Hypertension is the risk factor in 78% of cases followed by diabetes mellitus, smoking, and elevated plasma cholesterol level. Independence of the types of lacunar syndromes, patients with hypertension and diabetes mellitus are associated with high grade LA. None with normal blood pressure and plasma glucose had grade 3 or grade 4 LA (p < 0.05). In conclusion, evolving-stroke occurs in one- fifth of patients with “first-ever” lacunar infarct within the first 24 hours of stroke onset. SBI was found in 83% of cases. Hypertension and diabetes mellitus are associated with additional SBI and high grade LA. The severity of leuko-araiosis per se dictates the cerebrovascular risks.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Thajeb, P. , Lee, W. , Shih, C. , Thajeb, T. , Davis, J. , Harrigan, R. and Chang, L. (2010) Silent brain infarctions and leuko-araiosis in Chinese patients with first-ever acute lacunar strokes. Journal of Biomedical Science and Engineering, 3, 443-447. doi: 10.4236/jbise.2010.35061.

References

[1] Fisher, C.M. (1982) Lacunar strokes and infarcts: A review. Neurology, 32(8), 871.
[2] Ropper, A.H. and Brown, R.H. (2005) Cerebrovascular diseases. In: Adams and Victor’s Principles of Neurology, 8th Edition, McGraw-Hill Co., Inc., New York, 34, 682-684.
[3] Tuszynski, M.H., Petito, C.K. and Levy, D.E. (1989) Risk factors and clinical manifestations of pathologically verified lacunar infarctions. Stroke, 20(8), 990-999.
[4] Vermeer, S.E., Longstretch, W.I. and Kaudstaal, P.J. (2007) Silent brain infarcts: A systemic review. Lancet Neurology, 6(7), 611-619.
[5] Schmidt, R., Fazekas, F., Kapeller, P., Schmidt, H. and Hartung, H.P. (1999) MRI white matter hyperintensities: Three-year follow-up of the Austrian stroke prevention study. Neurology, 53(1), 132-139.
[6] Longstreth, W.T., Manolio, T.A., Arnold, A., Burke, G.L., Bryan, N., Jungreis, C.A., et al. (1996) Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: The cardiovascular health study. Stroke, 27(8), 1274-1282.
[7] Vermeer, S.E., Koudstaal, P.J., Oudkerk, M., Hofman, A. and Breteller, M.M.B. (2002) Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam scan study. Stroke, 33(1), 21-25.
[8] Kwon, H.M., Kim, B.J., Lee, S.H., Choi, S.H., Oh, B.H. and Yoon, B.W. (2006) Metabolic syndrome as an independent risk factor of silent brain infarction in healthy people. Stroke, 37(2), 466-470.
[9] Kobayashi, S., Okada, K. and Yamashita, K. (1991) Incidence of silent lacunar lesion in normal adults and its relation to cerebral blood flow and risk factors. Stroke, 22(4), 1379-1383.
[10] Folstein, M.F., Folstein, S.E. and Mc Hugh, P.R. (1975) Mini mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
[11] Thajeb, P., Thajeb, T. and Dai, D.F. (2007) Cross-cultural study using modified mini mental test (MMT) for healthy subjects and patients with various forms of vascular dementia. Journal of Clinical Neuroscience, 14(1), 236-241.
[12] Hachinski, V.C., Lassen, N.H. and Narshall, J. (1974) Multi-infarct dementia, a cause of mental deterioration in the elderly. Lancet, 2(7874), 207-210.
[13] Poirier, J. and Derouesne, C. (1985) The concept of cerebral lacunae from 1838 to the present (article in French, abstract in English). Review Neurology (Paris), 141(1), 3-17.
[14] Leifer, D., Buonanno. F.S. and Richardson, E.P.Jr. (1990) Clinicopathologic correlations of cranial magnetic resonance imaging of periventricular white matter. Neurology, 40(6), 911-918.
[15] Kario, K., Matsuo, T., Kobayashi, H., Asada, R. and Matsuo, M. (1996) Silent cerebral infaction is associated with hypercoagulability, endothelial cell damage, and high Lp(a) levels in elderly Japanese. Arteriosclerosis, Thrombosis, and Vascular Biology, 16(6), 734-741.
[16] Ishikawa, J., Tamura, Y., Hoshide, S., Eguchi, K., Ishikawa, S., Shimada, K. and Kario, K. (2007) Low-grade inflammation is a risk factor for clinical stroke events in addition to silent cerebral infarcts in Japanese older hypertensives: The Jichi medical school ABPM study, wave 1. Stroke, 38(3), 911-917.
[17] Grau-Olivares, M., Arboix, A., Bartre-Faz, D. and Junque, C. (2007) Neuropsychological abnormalities associated with lacunar infarction. Journal of Neurological Science, 257(1), 160-165.
[18] Thajeb, P., Thajeb, T. and Dai, D.F. (2007) Clinical analysis of first-ever acute ischemic stroke in the territory of paramedian mesencephalic arteries. Central Euro- pean Journal of Medicine, 2(1), 37-46.
[19] Schmidt, R., Enzinger, C., Ropele, S., Schmidt, H. and Fazekas, F. (2003) Progression of cerebral white matter lesions: 6-year results of the Austrian stroke prevention study. Lancet, 361(9374), 2046-2048.
[20] Dai, D.F., Thajeb, P., Tu, C.F., Chiang, F.T., Chen, C.H., Yang, R.B. and Chen, J.J. (2008) Plasma concentration of SCUBE1, a novel platelet protein, is elevated in patients with acute coronary syndrome and ischemic stroke. Jour- nal of the American College of Cardiology, 51(22), 2173- 2180.
[21] Kato, T., Inoue, T., Yamagishi, S., Morooka, T., Okimoto, T. and Node, K. (2006) Low-density lipoprotein subfractions and the prevalence of silent lacunar infarction in subjects with essential hypertension. Hypertension Research, 29(5), 303-307.

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.