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19-05-2011 | Stroke | Article

Subclinical cerebral damage prognostic in young stroke survivors


Free abstract

MedWire News: The presence of silent brain infarcts (SBIs) and leukoaraiosis (LA) warns of a poor long-term prognosis in young stroke survivors, say Finnish researchers.

SBIs on magnetic resonance imaging (MRI) predict recurrent stroke, but not vascular outcomes, Jukka Putaala (Helsinki University Central Hospital) and colleagues report in the journal Neurology.

"These findings… strengthen the view that SBIs at a young age may merely reflect specific types of cerebrovascular rather than universal and prognostically poor vascular disease," they say.

The team analyzed data on 655 unselected stroke patients, aged between 15 and 49 years, who had undergone MRI. This revealed SBIs in 86 (13.1%) patients, of whom 46 had a single SBI and 40 had multiple SBIs. There were 50 (5.6%) patients with LA, of whom 21 had mild changes and 29 had moderate or severe changes.

The presence of multiple SBIs raised patients' risk for recurrent stroke 2.48-fold over the average 8.7 years of follow-up. This association was independent of confounders including age, gender, vascular risk factors, TOAST (Trial of ORG 10172 in Acute Stroke Treatment) stroke subtype, and the presence of LA.

Multiple SBIs did not raise the risk for death from any cause or for a composite vascular outcome of myocardial infarction, stroke, revascularization, or vascular death. Single SBIs had no bearing on any outcome.

Having moderate or severe LA did not affect patients' risk for stroke or vascular outcomes. However, it raised their risk for dying 3.43-fold, after accounting for confounders including SBIs. Mild LA did not influence patient outcomes.

"Since SBIs and LA seem to be prognostically relevant, and because they are more sensitively detected with MRI than with CT [computed tomography], MRI should be the primary imaging method of choice in all eligible young patients with stroke," say the researchers.

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By Eleanor McDermid