Silent brain infarctions and leuko-araiosis in Chinese patients with first-ever acute lacunar strokes by ProQuest


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									J. Biomedical Science and Engineering, 2010, 3, 443-447                                                                 JBiSE
doi:10.4236/jbise.2010.35061 Published Online May 2010 (

Silent brain infarctions and leuko-araiosis in Chinese patients
with first-ever acute lacunar strokes
Peterus Thajeb1,2,3,4*, Wen-Yuan Lee2, Chung-Hung Shih5, Teguh Thajeb6, James Davis3, Rosanne
Harrigan3, Linda Chang3
  Center for Stroke Care and Prevention, Cathay General Hospital Sijhih, Sijhih, Taiwan, China;
  Section of Neurosurgery and Neurology, China Medical University Hospital, Taipei, Taiwan, China;
  Biomedical Science, Graduate Division, John A Burns School of Medicine, University of Hawaii at Manoa, Hawaii, USA;
  Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, China;
  Institute of Respiratory Therapy, Taipei Medical University, Taipei, Taiwan, China;
  Department of Internal Medicine, Landseed Hospital, Pingjen, Taiwan, China.

Received 3 January 2010; revised 12 January 2010; accepted 15 January 2010.

ABSTRACT                                                           MRI; Silent Brain Infarction
We report on silent brain infarction (SBI) and leuko-              1. INTRODUCTION
araiosis (LA) of 23 patients with clinically diagnosed
“first-ever” acute ischemic lacunar stroke. The lacu-              Elegant study on 1042 routine autopsied brains by Fisher
nar syndromes were pure motor hemiparesis (10),                    in 1965 [1,2], and data from 2,859 necropsied cases re-
pure sensory syndrome (2), ataxic hemiparesis (3),                 ported by Tuszynski et al. [3] suggest that lacunes occur
dysarthria clumsy hand syndrome (3), and sensory-                  in between 6% [3] and 11% [1,2] of cases, respectively.
motor deficit (5). Nineteen out of the 23 patients pre-            Approximately, eighty percent of these lacunes had no
sented with completed strokes on arrival to the hospi-             history of stroke and neurological deficit, and thus called
tal, and 4 (17%) developed evolving-stroke within 24               “asymptomatic” or “silent” lacunes [3,4]. During life,
hours of stroke onset. A lacune corresponded to the                the diagnosis of asymptomatic or subclinical silent lacu-
acute stroke could be found in all patients on brain               nes in the pre-era of MRI has been a difficult task for
magnetic resonance imaging (MRI), and in 18 (78%)                  several reasons. First, ethically a neurological healthy
on brain computed tomography (CT). MRI showed                      subject would not justify having an intensive laboratory
additional subclinical or asymptomatic “silent brain               work-up for any possible reason of unexpected intracra-
infarctions or lacunes” (SBI) in 19 (83%) of 23 pa-                nial silent lesion. Second, in the earlier days, before the
tients, and leuko-araiosis (LA) of moderate to severe              advent of MRI technique, a brain CT would not sensitive
degree (> grade 2) was present in 61% of patients al-              enough to detect a small lesion of less than 15 mm in a
though dementia was absent. Hypertension is the risk               clinically overt lacunar stroke. Therefore, the actual in-
factor in 78% of cases followed by diabetes mellitus,              cidence of subclinical silent lacunes in the general
smoking, and elevated plasma cholesterol level. Inde-              population, and in asymptomatic patients with cere-
pendence of the types of lacunar syndromes, patients               brovascular risk factors remains conjectural. Extensive
with hypertension and diabetes mellitus are associated             use of brain MRI in the past decade had suggested that
with high grade LA. None with normal blood pressure                prevalence of MRI-based diagnosis of silent brain in-
and plasma glucose had grade 3 or grade 4 LA (p <                  farction (SBI) ranged from 8% [5] to 28% [6]. These
0.05). In conclusion, evolving-stroke occurs in one-               SBIs included silent lacunes and silent non-lacunar in-
fifth of patients with “first-ever” lacunar infarct                farctions [5-8]. A screening health examination in Japan
within the first 24 hours of stroke onset. SBI was                 on 246 neurologically normal adults revealed 13% had
found in 83% of cases. Hypertension and diabetes                   possible silent lacunar lesions on brain MRI [9]. But
mellitus are associated with additional SBI and high               nothing is known about SBI in Chinese/Taiwanese with
grade LA. The severity of leuko-araiosis per se dic-               “first-ever” acute ischemic lacunar syndromes. This is-
tates the cerebrovascular risks.                                   sue will be addressed herein.
                                                                   2. PATIENTS AND METHODS
Keywords: Computed Tomography; First-Ever Stroke;
Lacune; Leuko-Araiosis; Magnetic Resonance Imaging;                Patients recruited in this study were a subset from the

Published Online May 2010 in SciRes.
444                           P. Thajeb et al. / J. Biomedical Science and Engineering 3 (2010) 443-447

authors’ consecutive stroke registry between January 1,        ing the frontal and posterior horn white matter), LA
2007 and December 31, 2008. Subjects with a lacunar            grade 3 (severe LA involving the whole rims of lateral
infarction due to small penetrating artery occlusion are
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