PREVALENCE AND RISK FACTORS OF ASYMPTOMATIC CEREBRAL INFARCTION

Acute stroke manifesting as focal neurological deficit is a leading cause of death and disability. Of interest is the problem of asymptomatic cerebral infarctions (AСI), in which there is focal medullary involvement unaccompanied by the development of focal symptoms. The role of AСI as a marker for the progression of vascular dementia and for the further development of symptomatic stroke has not been adequately explored. There are current instrumental (neuroimaging) criteria for diagnosing AСI. An update on the risk factors of AСI and their association with the further course of cerebrovascular involvement is analyzed. The results of a number of prospective studies conducted in the countries of Asia and Europe to investigate risk factors for AСI and their prognostic value are considered in detail. There is a relationship between hypertension, blood pressure instability, type 2 diabetes mellitus, some other factors, and a significantly increased risk for AСI. Based on the results of analyzing the data available in the literature, the authors demonstrate the association of prior AСI with the higher rates of progressive vascular cognitive impairments. A correlation is shown between prior AСI and an increased risk for further development of ischemic stroke accompanied by its clinical symptoms, which leads to disability. 

It is suggested that it is advisable to implement measures for secondary cardiovascular disease prevention, including the administration of antiaggregatory and antihypertensive agents, in patients with AСI. 

1. Гусев Е.И., Скворцова В.И., Мартынов М.Ю., Камчатнов П.Р. Церебральный инсульт: проблемы и решения. Вестник РГМУ 2006;(4):28–36. [Gusev E.I., Skvortsova V.I., Martynov M.Yu., Kamchatnov P.R. Cerebral apoplexy: problems and solutions. Vestnik RGMY = RSMU Herald 2006;(4):28–36. (In Russ.)].

2. Гусев Е.И., Скворцова В.И. Ишемия головного мозга. М.: Медицина, 2001. [Gusev E.I., Skvortsova V.I. Cerebral ischemia. Moscow: Meditsina, 2001. (In Russ.)].

3. Скворцова В.И., Леменев В.Л., Ахметов В.В. Эффективность хирургических и консервативных методов вторичной профилактики каротидного ишемического инсульта. Журнал неврологии и психиатрии им. С.С. Корсакова (Инсульт) 2005;105(13):3–7. [Skvortsova V.I., Lemenev V.L., Akhmetov V.V. Efficiency of surgical and conservative methods of secondary prevention of the carotid ischemic stroke. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova (Insul't) = S.S. Korsakov Journal of Neurology and Psychiatrics (Stroke) 2005;105(13):3–7. (In Russ.)].

4. Ritter M.A., Dittrich R., Ringelstein E.B. Silent brain infarcts. Nervenarzt 2011;82(8):1043–52.

5. Vermeer S.E., Den Heijer T., Koudstaal P.J. et al. Incidence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke 2003;34(2):392–6.

6. Longstreth W.T. Jr., Dulberg C., Manolio T. et al. Incidence, manifestations, and predictors of brain infarcts defined by serial cranial magnetic resonance imaging in the elderly: the Cardiovascular Health Study. Stroke 2002;33(10):2376–82.

7. Lee S.C., Park S.J., Ki H.K. et al. Prevalence and risk factors of silent cerebral infarction in apparently normal adults. Hypertension 2000;36(1):73–7.

8. Shinkawa A., Ueda K., Kiyohara Y. et al. Silent cerebral infarction in a community-based autopsy series in Japan. The Hisayama Study. Stroke 1995;26(3):380–5.

9. Kwon H.M., Kim B.J., Lee S.H. et al. Metabolic syndrome as an independent risk factor of silent brain infarction in healthy people. Stroke 2006;37(2):466–70.

10. Vermeer S.E., Longstreth W.Т. Jr., Koudstaal P.J. Silent brain infarcts: a systematic review. Lancet Neurol 2007;6(7):611–9.

11. Bokura H., Kobayashi S., Yamaguchi S. Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study. J Neurol 1998;245(2):116–22.

12. Das R.R., Seshadri S., Beiser A.S. et al. Prevalence and correlates of silent cerebral infarcts in the Framingham offspring study. Stroke 2008;39(11):2929–35.

13. Wahlund L.O., Barkhof F., Fazekas F. et al. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 2001;32(6):1318–22.

14. Bernick C., Kuller L., Dulberg C. et al. Silent MRI infarcts and the risk of future stroke: the cardiovascular health study. Neurology 2001;57(7):1222–9.

15. Masana Y., Iwamoto F., Yamada M. et al. Prevalence and risk factors for silent lacunar infarct in white matter lesion-brain multiphasic screening. No To Shinkei 2003;55(12):1027–32.

16. Fisher М. Lacunar infarcts – a review. Cerebrovasc Dis 1991;1(6):311–20.

17. Uehara T., Tabuchi M., Mori E. Risk factors for silent cerebral infarcts in subcortical white matter and basal ganglia. Stroke 1999;30(2):378–82.

18. Mathiesen E., Waterloo K., Joakimsen O. et al. Reduced neuropsychological test performance in asymptomatic carotid stenosis: The Tromso Study. Neurology 2004;62(5): 695–701.

19. Kotani K., Osaki Y., Sakane N. et al. Risk factors for silent cerebral infarction in the elderly. Arch Med Res 2004;35(6):522–4.

20. Waldstein S.R., Siegel E.L., Lefkowitz D. et al. Stress-induced blood pressure reactivity and silent cerebrovascular disease. Stroke 2004;35(6):1294–8.

21. Kario K., Pickering T.G., Umeda Y. et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003;107(10):1401–6.

22. Kario K., Eguchi K., Hoshide S. et al. U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor. J Am Coll Cardiol 2002;40(1):133–41.

23. Eguchi K., Kario K., Hoshide S. et al. Greater change of orthostatic blood pressure is related to silent cerebral infarct and cardiac overload in hypertensive subjects. Hypertens Res 2004;27(4):235–41.

24. Kario K., Pickering T.G. Blood pressure variability in elderly patients. Lancet 2000;355(9215):1645–6.

25. Hoshide S., Kario K. Low-density lipoprotein subfraction as a new risk factor for silent cerebral infarction in hypertensive patients. Hypertens Res 2006;29(5):297–8.

26. Kwon H.M., Kim B.J., Park J.H. Significant association of metabolic syndrome with silent brain infarction in elderly people. J Neurol 2009;256(11):1825–31.

27. Gazdzinski S., Kornak J., Weiner M.W., Meyerhoff D.J. Body mass index and magnetic resonance markers of brain integrity in adults. Ann Neurol 2008;63(5):652–7.

28. Lusis A.J., Attie A.D., Reue K. Metabolic syndrome: From epidemiology to systems biology. Nat Rev Genet 2008;9(11):819–30.

29. Kawamoto R., Tomita H., Oka Y., Kodama A. Metabolic syndrome as a predictor of ischemic stroke in elderly persons. Intern Med 2005;44(9):922–7.

30. Miao Q., Paloneva T., Tuisku S. et al. Arterioles of the lenticular nucleus in CADASIL. Stroke 2006;37(9):2242–7.

31. Kruit M.C, van Buchem M.A., Hofman P.A. et al. Migraine as a risk factor for subclinical brain lesions. JAMA 2004;291(4):427–34.

32. Vermeer S.E., Koudstaal P.J., Oudkerk M. et al. Prevalence and risk factors of silent brain infarcts in the population based Rotterdam Scan Study. Stroke 2002;33(1):21–5.

33. Gupta V. Silent or non-clinical infarct-like lesions in the posterior circulation territory in migraine: brain hypoperfusion or hyperperfusion? Brain 2006;129(Pt 1):E39.

34. Kruit M.С., Launer L.J., van Buchem M.A. et al. MRI findings in migraine. Rev Neurol (Paris) 2005;161(6–7):661–5.

35. van Dijk E.J., Prins N.D., Vermeer S.E. et al. C-reactive protein and cerebral smallvessel disease: the Rotterdam Scan Study. Circulation 2005;112(6):900–5.

36. Hoshi T., Kitagawa K., Yamagami H. et al. Relations of serum high-sensitivity C-reactive protein and interleukin-6 levels with silent brain infarction. Stroke 2005;36(4):768–72.

37. Fassbender K., Bertsch T., Mielke O. et al. Adhesion molecules in cerebrovascular diseases. Evidence for an inflammatory endothelial activation in cerebral largeand small-vessel disease. Stroke 1999;30(8): 1647–50.

38. Hassan A., Hunt B.J., O’Sullivan M. et al. Markers of endothelial dysfunction in lacunar infarction and ischaemic leukoaraiosis. Brain 2003;126(Pt 2):424–32.

39. Dirnagl U., Iadecola C., Moskowitz M.A. Pathobiology of ischaemic stroke: An integrated view. Trends Neurosci 1999;22(9):391–7.

40. Park K., Yasuda N., Toyonaga S. et al. Significant associations of metabolic syndrome and its components with silent lacunar infarction in middle aged subjects. J Neurol Neurosurg Psychiatry 2008;79(6):719–21.

41. Serizawa M., Nabika T., Ochiai Y. et al. Association between PRKCH gene polymorphisms and subcortical silent brain infarction. Atherosclerosis 2008;199(2):340–5.

42. Kimberly W.T., Gilson A., Rost N.S. et al. Silent ischemic infarcts are associated with hemorrhage burden in cerebral amyloid angiopathy. Neurology 2009;72(14):1230–5.

43. Kario K., Matsuo T., Kobayashi H. et al. Hyperinsulinemia and hemostatic abnormalities аre аssociated with silent lacunar cerebral infarcts in elderly hypertensive subjects. J Am Coll Cardiol 2001;37(3):871–7.

44. Vermeer S.E., Prins N.D., den Heijer T. et al. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 2003;348(13):1215–22.

45. Zhefeng Q., Bokura H., Iijima K. et al. The influences of silent cerebral infarction and hypertension on brain atrophy in normal adults. Nihon Ronen Igakkai Zasshi 2008;45(2):175–81.

46. Bernick C., Kuller L., Dulberg C. et al. Silent MRI infarcts and the risk of future stroke: the cardiovascular health study. Neurology 2001;57(7):1222–9.

47. Adachi T., Kobayashi S., Yamaguchi S. Frequency and pathogenesis of silent subcortical brain infarction in acute first-ever ischemic stroke. Intern Med 2002;41(2):103–8. 48. Kobayashi S., Okada K., Koide H. et al. Subcortical silent brain infarction as a risk factor for clinical stroke. Stroke 1997;28(10):1932–9.