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Silent Ischemic Lesions After Stroke Predict Future Events

Asymptomatic lesions that show up on MRI may be surrogate marker for recurrence

WEDNESDAY, Dec. 13 (HealthDay News) -- Silent lesions that can be observed through magnetic resonance imaging (MRI) may be a surrogate marker for recurrence of stroke, according to study findings published in the December issue of the Archives of Neurology.

Steven Warach, M.D., Ph.D., of the National Institute of Neurological Disorders and Stroke in Bethesda, Md., and colleagues conducted a study of 120 patients with acute ischemic stroke who underwent MRI within 24 hours of the stroke and again five days later. A subset of 68 patients underwent follow-up MRI up to 90 days later.

Clinical outcome data was available for 104 patients. Early silent lesion recurrence, defined as new asymptomatic lesions seen on five-day MRI, was observed in 35 (33.7 percent) of the 104 patients. Late silent lesion recurrence, defined as lesions seen on 30- or 90-day MRI, occurred in 15 (22.1 percent) of the 68 cases in the subset. During the mean follow-up period of 19.3 months, eight patients had a recurrent ischemic stroke, three had a transient ischemic attack and there were three vascular deaths. Recurrence of early and late silent lesions independently predicted all three types of events.

"Based on the results of our study, patients with silent ischemic lesion recurrence over the early weeks after an index stroke may be an optimal target for early aggressive stroke prevention therapy," the authors conclude. "Pharmacologic reduction in the lesion recurrence rate over the initial weeks may be a surrogate for reduction in clinical stroke recurrence over the following years."

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