Silent brain infarctions in patients with acute cardioembolic stroke

Introduction and aim

The advances and the wide use of brain imaging have considerably increased the prevalence of silent brain infarctions (SBI). We aim in this study to determine the prevalence of SBI in patients presenting with acute cardioembolic stroke and the predictive cardiovascular risk factors.

Methods

This retrospective study included 267 patients presenting with acute cardioembolic stroke in the emergency and/or neurology departments of the Hassan II University Hospital Center. Clinical, biological and echocardiographic characteristics were recorded. All patients were screened for SBI by brain imaging.

Results

The prevalence of SBI in our series was 46%. A group of 203 non-valvular patients and a group of 64 valvular patients were distinguished. In non-valvular group, the average age was 72.97 ± 10.53 years. The prevalence of SBI was 45.3%. Forty-four percent of patients with SBI had atrial fibrillation (AF). In multivariate regression analysis, the history of previous stroke, CHA₂DS₂-VASc Score ≥ 4, enlarged left atrium (LA), the association of AF with enlarged LA and the lability of International Normalized Ratio in patients initially treated with anticoagulants were significantly associated with the occurrence of SBI (P = 0.013, P = 0.032, P = 0.0001, P = 0.01, P = 0.03, respectively). Territorial location was significantly the most frequent (P = 0.007). In valvular group, the average age was 57.19 ± 14.38 years. The prevalence of SBI was 48.4%. In multivariate regression analysis, SBI were significantly associated with moderate or severe mitral stenosis (P = 0.02) and with the enlarged LA (P = 0.02). In all patients, Modified Rankin Scale at 3 months of discharge from the acute stroke was significantly higher (mRS ≥ 3) in patients with SBI (P = 0.04).

Conclusions

SBI requires good management of associated cardiovascular risk factors in a population presenting with initial cardioembolic stroke.