Ricci S, Celani M G, La Rosa F, Righetti E, Duca E, Caputo N
Clinica Neurologica, Perugia University Hospital, Italy.
Stroke. 1993 May;24(5):647-51. doi: 10.1161/01.str.24.5.647.
The relative frequency of computed tomographic evidence of old cerebral infarctions without prior history of stroke, and their effect on short- and long-term outcome of patients with first-ever ischemic stroke, are currently unknown. Silent infarctions may relate to specific risk factors and may influence the rate of survival free of handicap.
We studied the prevalence of such lesions in patients registered with SEPIVAC, a community-based survey of stroke incidence and outcome in the Sixth Local Health Unit of Umbria, Italy. Of 375 first-ever strokes, 209 patients with cerebral infarction (computed tomogram done within 30 days after the stroke) were included in this study. Computed tomograms were reviewed blindly, and cases were classified as having a single lesion or multiple lesions; in the latter case, it was assumed that at least one silent brain infarction was present. The two groups were compared in terms of risk factors and outcome. To avoid a selection bias, these patients were also compared with 68 patients who were not submitted to computed tomography but were judged on clinical grounds to have a > 90% probability of having suffered a cerebral infarction.
Risk factors and outcome did not differ between patients without and with a computed tomogram. In the latter group, 80 patients (38.3%; 95% confidence interval, 31.7%-44.9%) had silent brain infarction. Male sex (odds ratio, 1.84; 95% confidence interval, 1-3.4), ischemic changes on an electrocardiogram (odds ratio, 2.5; 95% confidence interval, 1.3-4.9), and--in the multivariate analysis--hypertension (odds ratio, 1.46; 95% confidence interval, 1.1-2) were significantly more frequent in these patients. Outcome at 1, 6, and 12 months was not influenced by the presence of silent infarctions.
This community-based study shows that silent brain infarctions in patients with first-ever stroke are not significantly related to risk factors commonly described in hospital-based series (atrial fibrillation, transient ischemic attack, etc.); rather, silent infarctions seem to be a marker of widespread vascular disease.
既往无卒中病史的陈旧性脑梗死的计算机断层扫描证据的相对频率，及其对首次缺血性卒中患者短期和长期预后的影响，目前尚不清楚。无症状性梗死可能与特定危险因素有关，并可能影响无残疾生存的几率。
我们在SEPIVAC登记的患者中研究了此类病变的患病率，SEPIVAC是意大利翁布里亚第六地方卫生单位基于社区的卒中发病率和预后调查。在375例首次卒中患者中，209例脑梗死患者（卒中后30天内进行了计算机断层扫描）纳入本研究。对计算机断层扫描进行盲法审查，病例分为有单个病变或多个病变；在后一种情况下，假定至少存在一个无症状性脑梗死。比较两组的危险因素和预后。为避免选择偏倚，还将这些患者与68例未进行计算机断层扫描但根据临床判断有>90%脑梗死可能性的患者进行了比较。
有和没有计算机断层扫描的患者之间的危险因素和预后没有差异。在后一组中，80例患者（38.3%；95%置信区间，31.7%-44.9%）有无症状性脑梗死。男性（比值比，1.84；95%置信区间，1-3.4）、心电图缺血性改变（比值比，2.5；95%置信区间，1.3-4.9）以及在多变量分析中高血压（比值比，1.46；95%置信区间，1.1-2）在这些患者中显著更常见。1、6和12个月时的预后不受无症状性梗死存在的影响。
这项基于社区的研究表明，首次卒中患者的无症状性脑梗死与基于医院系列中通常描述的危险因素（房颤、短暂性脑缺血发作等）没有显著关系；相反，无症状性梗死似乎是广泛血管疾病的一个标志。
