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Silent brain infarcts and leukoaraiosis in young adults with first-ever ischemic stroke

From the Department of Neurology (J.P., M. Kurkinen, V.T., M. Kaste, T.T.) and Helsinki Medical Imaging Center (O.S.), Helsinki University Central Hospital, Finland.

Address correspondence and reprint requests to Dr. Jukka Putaala, Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290, Helsinki, Finland jukka.putaala{at}hus.fi

Background: We recently observed that 13% of 1,008 consecutive adults aged 15–49 years with first-ever ischemic stroke had one or more silent brain infarcts (SBIs), and more than 5% presented with leukoaraiosis on CT or MRI. We sought to investigate the features of and risk factors for magnetic resonance (MR)-defined SBIs and leukoaraiosis in these patients.

Methods: We analyzed the radiologic features of SBIs and leukoaraiosis in MR-scanned patients (n = 669) blinded to clinical data and examined their relation with subtype of the overt stroke. We used logistic regression to identify factors predisposing to SBIs and leukoaraiosis.

Results: Of the 669 patients included, 86 (13%) had SBIs, 50 (7%) had leukoaraiosis, 17 (3%) had both, and 550 had no SBIs or leukoaraiosis and served as controls. The majority (54%) had a single SBI, 20% had two SBIs, and 27% had three or more SBIs. Most SBIs were located in basal ganglia (39%) or subcortical regions (21%), but cerebellar SBIs also were rather frequent (15%). Leukoaraiosis was mainly mild to moderate. Independent risk factors for SBIs were type 1 diabetes (odds ratio [OR] 5.78, 95% confidence interval 2.37–14.10), obesity (OR 2.12, 1.07–4.19), smoking (OR 1.69, 1.05–2.72), and increasing age (OR 1.08, 1.04–1.13). Risk factors for leukoaraiosis were type 1 diabetes (OR 9.75, 3.39–28.04), obesity (OR 2.42, 1.04–5.68), female sex (OR 2.25, 1.16–4.34), and increasing age (OR 1.19, 1.10–1.29). Small-vessel disease was the predominant cause of stroke in both those with SBIs (31%) and leukoaraiosis (44%).

Conclusions: Silent brain infarcts and leukoaraiosis are not uncommon among young stroke patients—type 1 diabetes being the strongest risk factor.

Abbreviations: BMI = body mass index; CADASIL = cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; CI = confidence interval; LA = leukoaraiosis; MR = magnetic resonance; OR = odds ratio; PACNS = primary angiitis of the CNS; PVH = periventricular hyperintensity; SBI = silent brain infarct; SLE = systemic lupus erythematosus; TOAST = Trial of Org 10172 in Acute Stroke Treatment.

Supplemental data at www.neurology.org

Supported by the Helsinki University Central Hospital, the University of Helsinki, and the Päivikki and Sakari Sohlberg Foundation.

Disclosure: The authors report no disclosures.

Received October 21, 2008. Accepted in final form February 27, 2009.