Skip to main content
SpringerLink
Log in

Subclinical Vascular Brain Injury

  • Chapter
Ischemic Stroke Therapeutics

  • 2163 Accesses

Abstract

Subclinical vascular brain injury is common in older persons and may be incidentally discovered on brain scans. Most subclinical vascular injury is caused by cerebral small vessel disease—silent central nervous system infarcts, white matter hyperintensities of presumed vascular origin, and microbleeds are common manifestations. These vascular lesions are associated with increased risk for future stroke. Additionally, these lesions may be “covert” rather than truly silent or subclinical, in that they are also associated with cognitive decline and gait impairment despite the absence of a history of stroke. In this chapter, common clinical scenarios involving subclinical vascular brain injury and its management are described, highlighting current areas of controversy. The author discusses the safety of anticoagulation in patients with microbleeds, management of vascular cognitive impairment caused by subclinical vascular brain injury, and the implications of silent stroke for vascular risk reduction strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Callaghan BC, Kerber KA, Pace RJ, Skolarus LE, Burke JF. Headaches and neuroimaging: high utilization and costs despite guidelines. JAMA Intern Med. 2014;174:819–21.

    Article  PubMed  Google Scholar 

  2. Vernooij MW, Ikram MA, Tanghe HL, et al. Incidental findings on brain MRI in the general population. N Engl J Med. 2007;357:1821–8.

    Article  CAS  PubMed  Google Scholar 

  3. Prins ND, van Dijk EJ, den Heijer T, et al. Cerebral small-vessel disease and decline in information processing speed, executive function and memory. Brain. 2005;128:2034–41.

    Article  PubMed  Google Scholar 

  4. Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348:1215–22.

    Article  PubMed  Google Scholar 

  5. Debette S, Beiser A, DeCarli C, et al. Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality: the Framingham Offspring Study. Stroke. 2010;41:600–6.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Sonnen JA, Larson EB, Crane PK, et al. Pathological correlates of dementia in a longitudinal, population-based sample of aging. Ann Neurol. 2007;62:406–13.

    Article  PubMed  Google Scholar 

  7. Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke. 2002;33:21–5.

    Article  PubMed  Google Scholar 

  8. Viswanathan A, Greenberg SM. Cerebral amyloid angiopathy in the elderly. Ann Neurol. 2011;70:871–80.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Smith EE. Leukoaraiosis and stroke. Stroke. 2010;41:S139–43.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12:822–38.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Nandigam RN, Viswanathan A, Delgado P, et al. MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength. AJNR Am J Neuroradiol. 2009;30:338–43.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. January CT, Wann LS, Alpert JS, et al. AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199–267.

    Article  PubMed  Google Scholar 

  13. Greenberg SM, Vernooij MW, Cordonnier C, et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol. 2009;8:165–74.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Shoamanesh A, Kwok CS, Benavente O. Cerebral microbleeds: histopathological correlation of neuroimaging. Cerebrovasc Dis. 2011;32:528–34.

    Article  CAS  PubMed  Google Scholar 

  15. Cordonnier C, Potter GM, Jackson CA, et al. Improving interrater agreement about brain microbleeds: development of the Brain Observer MicroBleed Scale (BOMBS). Stroke. 2009;40:94–9.

    Article  PubMed  Google Scholar 

  16. Gregoire SM, Chaudhary UJ, Brown MM, et al. The Microbleed Anatomical Rating Scale (MARS): reliability of a tool to map brain microbleeds. Neurology. 2009;73:1759–66.

    Article  CAS  PubMed  Google Scholar 

  17. Smith EE, Werring DJ, McCreary CR. Relationship of cerebral microbleeds to other imaging findings. In: Werring DJ, editor. Microbleeds: from pathophysiology to clinical practice. Cambridge: Cambridge University Press; 2011. p. 71–8.

    Chapter  Google Scholar 

  18. Linn J, Halpin A, Demaerel P, et al. Prevalence of superficial siderosis in patients with cerebral amyloid angiopathy. Neurology. 2010;74:1346–50.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Knudsen KA, Rosand J, Karluk D, Greenberg SM. Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria. Neurology. 2001;56:537–9.

    Article  CAS  PubMed  Google Scholar 

  20. Vernooij MW, Haag MD, van der Lugt A, et al. Use of antithrombotic drugs and the presence of cerebral microbleeds: the Rotterdam Scan Study. Arch Neurol. 2009;66:714–20.

    Article  PubMed  Google Scholar 

  21. Greenberg SM, Eng JA, Ning M, Smith EE, Rosand J. Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage. Stroke. 2004;35:1415–20.

    Article  PubMed  Google Scholar 

  22. Biffi A, Halpin A, Towfighi A, et al. Antiplatelet agents and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology. 2010;75:693–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Morgenstern LB, Hemphill 3rd JC, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41:2108–29.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Etten ES, Auriel E, Haley KE, et al. Incidence of symptomatic hemorrhage in patients with lobar microbleeds. Stroke. 2014;45(8):2280–5.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806–17.

    Article  CAS  PubMed  Google Scholar 

  26. Dowlatshahi D, Butcher KS, Asdaghi N, et al. Poor prognosis in warfarin-associated intracranial hemorrhage despite anticoagulation reversal. Stroke. 2012;43:1812–7.

    Article  CAS  PubMed  Google Scholar 

  27. Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367:1903–12.

    Article  CAS  PubMed  Google Scholar 

  28. Charidimou A, Kakar P, Fox Z, Werring DJ. Cerebral microbleeds and the risk of intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2013;84:277–80.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Potter GM, Doubal FN, Jackson CA, et al. Counting cavitating lacunes underestimates the burden of lacunar infarction. Stroke. 2010;41:267–72.

    Article  PubMed  Google Scholar 

  30. Moreau F, Patel S, Lauzon ML, et al. Cavitation following acute symptomatic lacunar stroke depends on time, location and MRI sequence. Stroke. 2012;43:1837–42.

    Article  PubMed  Google Scholar 

  31. Smith EE, Schneider JA, Wardlaw JM, Greenberg SM. Cerebral microinfarcts: the invisible lesions. Lancet Neurol. 2012;11:272–82.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Vermeer SE, Longstreth Jr WT, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6:611–9.

    Article  PubMed  Google Scholar 

  33. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9:689–701.

    Article  PubMed  Google Scholar 

  34. Gorelick PB, Scuteri A, Black SE, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:2672–713.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–236.

    Article  PubMed  Google Scholar 

  36. Dufouil C, Chalmers J, Coskun O, et al. Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke: the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy. Circulation. 2005;112:1644–50.

    Article  PubMed  Google Scholar 

  37. Cavalieri M, Schmidt R, Chen C, et al. B vitamins and magnetic resonance imaging-detected ischemic brain lesions in patients with recent transient ischemic attack or stroke: the VITAmins TO Prevent Stroke (VITATOPS) MRI-substudy. Stroke. 2012;43:3266–70.

    Article  CAS  PubMed  Google Scholar 

  38. Weber R, Weimar C, Blatchford J, et al. Telmisartan on top of antihypertensive treatment does not prevent progression of cerebral white matter lesions in the prevention regimen for effectively avoiding second strokes (PRoFESS) MRI substudy. Stroke. 2012;43:2336–42.

    Article  PubMed  Google Scholar 

  39. Mok VC, Lam WW, Fan YH, et al. Effects of statins on the progression of cerebral white matter lesion: post hoc analysis of the ROCAS (Regression of Cerebral Artery Stenosis) study. J Neurol. 2009;256:750–7.

    Article  CAS  PubMed  Google Scholar 

  40. ten Dam VH, van den Heuvel DM, van Buchem MA, et al. Effect of pravastatin on cerebral infarcts and white matter lesions. Neurology. 2005;64:1807–9.

    Article  PubMed  Google Scholar 

  41. Launer LJ, Miller ME, Williamson JD, et al. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurol. 2011;10:969–77.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:2064–89.

    Article  PubMed  Google Scholar 

  43. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:227–76.

    Article  PubMed  Google Scholar 

  44. Vermeer SE, Hollander M, van Dijk EJ, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam Scan Study. Stroke. 2003;34:1126–9.

    Article  PubMed  Google Scholar 

  45. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2014;129:S1–45.

    Article  PubMed  Google Scholar 

  46. Sveinbjornsdottir S, Sigurdsson S, Aspelund T, et al. Cerebral microbleeds in the population based AGES-Reykjavik study: prevalence and location. J Neurol Neurosurg Psychiatry. 2008;79:1002–6.

    Article  CAS  PubMed  Google Scholar 

  47. Smith EE, O’Donnell M, Dagenais G, et al. Early cerebral small vessel disease and brain volume, cognition, and gait. Ann Neurol. 2014;77(2):251–61.

    Article  Google Scholar 

  48. Vernooij MW, van der Lugt A, Ikram MA, et al. Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study. Neurology. 2008;70:1208–14.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, 1403 29 Street NW, Calgary, AB, Canada, T2N 2T9

    Eric E. Smith M.D., M.P.H.

Authors
  1. Eric E. Smith M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric E. Smith M.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Admiral Pihl Professor and Chairman of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA

    Bruce Ovbiagele

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Smith, E.E. (2016). Subclinical Vascular Brain Injury. In: Ovbiagele, B. (eds) Ischemic Stroke Therapeutics. Springer, Cham. https://doi.org/10.1007/978-3-319-17750-2_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17750-2_26

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17749-6

  • Online ISBN: 978-3-319-17750-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation