Stroke: What are the phenotypic characteristics of chronic recessive cerebral infarction?

Chronic occult cerebral infarction (CBI) refers to focal, presumed ischemic lesions found on brain imaging in patients with no obvious history of acute neurological dysfunction
.

Patients with CBI have a significant increase in risk of acute ischemic stroke (AIS) by 2-3 times

Stroke

Previous studies on the role of CBI in patients with AIS, due to the use of computed tomography (CT) imaging, are not sensitive in detecting small CBI, nor are they specific in distinguishing CBI from other brain diseases
.

Some studies have used magnetic resonance imaging (MRI), but reliable CBI diagnostic imaging standards have only recently been proposed
.

Most existing studies compare any CBI patients with patients without CBI, but do not consider the imaging phenotype of CBI lesions

diagnosis

In AIS patients, CBI may convey clues to potential vascular risk factors and the cause of stroke
.

Due to methodological flaws in existing studies, the AIS work guidelines did not include information on the combined CBI to guide the diagnosis of AIS patients

Vascular Due to the methodological defects of the existing research, the AIS work guide does not include information on the combined CBI to guide the diagnosis of AIS patients

CBI includes cortical infarction and lacunar (cavitary), subcortical large area (non-cavitary) infarction, and cerebellar and brainstem lesions
.

In addition, they also determined the vascular risk factors based on the phenotype of CBI, and resolved the association between CBI and undifferentiated white matter hyperintensity (WMHs)

They included 1546 consecutive first-onset AIS patients with magnetic resonance imaging from January 2015 to December 2017
.

The main findings are the CBI phenotype, its relative frequency, location, and its association with vascular risk factors

CBI was present in 574/1546 patients (37% [95% CI, 35%-40%]), and there were a total of 950 CBI lesions
.

The most common location of CBI is 295/950 (31%) of the cerebellum, 292/950 (31%) of the inferior and upper cortex, and 213/950 (24%) of the cortex

The vascular risk status and the severity of white matter hyperplasia (19% if there is no white matter hyperplasia, 63% for severe white matter hyperplasia, P<0.
001) are related to the presence of any CBI
.

Atrial fibrillation is related to cortical lesions (adjusted odds ratio, 2.
032 [95% CI, 1.
041-3.
967])
.

Patients with an embolic CBI phenotype had a higher median score on the NIHSS scale at the time of admission (NIHSS median, 5[2-10], P=0.
025)
.

More than one-third of first-time AIS patients have CBI
.

Their location and phenotype determined by MRI are different from previous studies using computed tomography imaging
.

Among AIS patients, those with additional CBI represent a high-risk vascular subgroup, and the association of CBI with different phenotypes with different risk factor profiles may point to a differential cause of AIS
.

Among AIS patients, those with additional CBI represent a high-risk vascular subgroup, and the association of CBI with different phenotypes with different risk factor profiles may point to a differential cause of AIS
.

Original source:
Vynckier J, Kaesmacher J, Wardlaw JM, et al.

Phenotypes of Chronic Covert Brain Infarction in Patients With First-Ever Ischemic Stroke: A Cohort Study.
Stroke.

Phenotypes of Chronic Covert Brain Infarction in Patients With First-Ever Ischemic Stroke:

 

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