In this post, I link to and excerpt from Prevention of Stroke in Patients With Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association [PubMed Abstract] [Full-Text HTML] [Full-TextPDF]. Stroke. 2017 Feb;48(2):e44-e71.
All that follows is from the above article.
Two decades of epidemiological research shows that silent cerebrovascular disease is common and is associated with future risk for stroke and dementia. It is the most common incidental finding on brain scans. To summarize evidence on the diagnosis and management of silent cerebrovascular disease to prevent stroke, the Stroke Council of the American Heart Association convened a writing committee to evaluate existing evidence, to discuss clinical considerations, and to offer suggestions for future research on stroke prevention in patients with 3 cardinal manifestations of silent cerebrovascular disease: silent brain infarcts, magnetic resonance imaging white matter hyperintensities of presumed vascular origin, and cerebral microbleeds. The writing committee found strong evidence that silent cerebrovascular disease is a common problem of aging and that silent brain infarcts and white matter hyperintensities are associated with future symptomatic stroke risk independently of other vascular risk factors. In patients with cerebral microbleeds, there was evidence of a modestly increased risk of symptomatic intracranial hemorrhage in patients treated with thrombolysis for acute ischemic stroke but little prospective evidence on the risk of symptomatic hemorrhage in patients on anticoagulation. There were no randomized controlled trials targeted specifically to participants with silent cerebrovascular disease to prevent stroke. Primary stroke prevention is indicated in patients with silent brain infarcts, white matter hyperintensities, or microbleeds. Adoption of standard terms and definitions for silent cerebrovascular disease, as provided by prior American Heart Association/American Stroke Association statements and by a consensus group, may facilitate diagnosis and communication of findings from radiologists to clinicians.
Neuroimaging signs of silent cerebrovascular disease are highly prevalent in older people. Although many radiological manifestations and secondary consequences are now known, the best-defined manifestations—in terms of radiological definition, prevalence, and clinical associations—are silent brain infarcts, white matter lesions of presumed vascular origin, and microbleeds (Figure 1). Approximately 25% of people >80 years of age have ≥1 silent brain infarcts.1 The prevalence of silent cerebrovascular disease exceeds, by far, the prevalence of symptomatic stroke. It has been estimated that for every symptomatic stroke, there are ≈10 silent brain infarcts.2 As a result of this high prevalence, silent cerebrovascular disease is the most commonly encountered incidental finding on brain imaging.3