A 47-year-old man had an acute ischemic stroke (IS); brain MRI revealed multiple silent old IS (figure 1A). A comprehensive workup, including prolonged cardiac monitoring (cumulated duration of 25 days) and cardiac transthoracic/transesophageal echography, was negative. Eleven months later, despite statin and aspirin therapy, a new symptomatic embolic IS of undetermined source occurred (figure ...

Antiplatelet resistance is emerging as a significant factor in effective secondary stroke prevention. Prevalence of aspirin and clopidogrel resistance is dependent upon laboratory test and remains contentious. Large studies in cardiovascular disease populations have demonstrated worse ischemic outcomes in patients with antiplatelet resistance, particularly in patients with coronary stents. Thro...

A trial fibrillation is a common cardiac dysrhythmia / \ of the elderly, and stroke is its most devastating JL ^ complication. Six years ago in Stroke, we discussed controversies surrounding the prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Since then, six recent randomized trials have changed the approach to stroke prevention for AF patients.Above all else, the ra...

The risk of systemic embolism associated with atrial fibrillation (AF) in patients with rheumatic mitral valve disease has long been appreciated. In only the past decade has it become clear that nonrheumatic (nonvalvulopathic) AF is a marker of increased risk for ischemic stroke.Several recent clinical and epidemiologic surveys have confirmed this association (Table 1) and suggest a fivefold in...

Right-to-left shunt (RLS) is associated with cryptogenic stroke and migraine. Herein we investigated the relationship between RLS and silent lacunar infarcts in patients with migraine. A total of 263 patients with migraine who met eligibility criteria were enrolled from January 2010 to December 2011, among which 127 subjects fell into RLS group. Baseline demographics were comparable between RLS...

BACKGROUND AND PURPOSE Silent infarcts are frequently found on MRIs of brains of healthy elderly persons (aged >60 years). The purpose of this study was to investigate the prevalence and determinants of silent infarcts in a population of patients with clinically manifest vascular disease. METHODS To detect silent infarcts, MR images were made in 308 participants of the Second Manifestations o...

BACKGROUND AND PURPOSE Metabolic syndrome (MetS) is a recognized risk factor for stroke, but it is unclear whether MetS is also related to subclinical ischemic lesions. We examined the association of MetS with the prevalence of silent brain infarction, periventricular hyperintensity, and subcortical white matter lesions in healthy adults. METHODS We conducted a cross-sectional study in 1151 J...

Addressing subsyndromal depression in cerebrovascular conditions, diabetes, and obesity reduces morbidity and risk of major depression. However, depression may be masked because self-reported symptoms may not reveal dysphoric (sad) mood. In this study, the first wave (2,812 elders) from the New Haven Epidemiological Study of the Elderly (EPESE) was used. These population-weighted data combined ...

Silent brain infarcts (SBIs) are detected by neuroimaging in approximately 20% of elderly patients in population-based studies. Limited evidence is available for hypertensives at low cardiovascular risk countries. Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study (ISSYS) is aimed to assess the prevalence and risk factors of SBIs in a hypertensive Mediterranean po...

BACKGROUND AND PURPOSE There have been few studies of the incidence of silent cerebral infarction detected by magnetic resonance imaging in patients with presenile or senile major depression. METHODS We examined silent cerebral infarction in patients with presenile and senile major depression who were diagnosed at Hiroshima Prefectural Hospital. The diagnostic criteria of the American Psychia...