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Department of Neurology (Drs. Chodosh, Kase, and Wolf, and Mr. Furtado), Boston University School of Medicine, Boston, MA; the Biometry and Field Studies Branch (Dr. Foulkes), NINCDS, Bethesda, MD; the Neurological Institute (Dr. Mohr), Columbia-Presbyterian Medical Center, New York, NY; the Department of Neurology (Dr. Hier), Michael Reese Hospital, Chicago, IL; and the Department of Neurology (Dr. Price), University of Maryland. Baltimore, MD.
Previous brain infarctions seen on CT are common in the absence of history of stroke. Eleven percent of patients (135/1,203) without stroke history had ischemic lesions on their first CT, unrelated to the presenting stroke. Stroke Data Bank files were reviewed to determine whether the occurrence, location, and CT characteristics of those lesions are associated with their undetected status. Two distinct patterns were seen: (1) Small lesions of 1 cm or less were left hemisphere predominant and involved the deep structures of the brain; the majority of these were clinically silent. (2) Lesions greater than 1 cm occurred more frequently in the right hemisphere and were mostly superficial; these infarcts produced signs unrecognized by the patient or family. Risk factors for silent stroke were similar to those for stroke in general. Frequencies of in-hospital complications and 30-day fatality rates from the presenting stroke were not influenced by the existence of a prior silent stroke.
Address correspondence and reprint requests to Dr. Kase, Department of Neurology, Boston University School of Medicine, 720 Harrison Avenue, Suite 600, Boston, MA 02118.
Supported by the Stroke Data Bank (SDB) under contracts N01-NS-2-2302, N01-NS-2-2384, N01-NS-2-2398, N01-NS-2-2399, and N01-NS-6-2305 from the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS).
Received February 16, 1988. Accepted for publication in final form May 19, 1988.
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