title: Silent ischemic lesions in young adults with first stroke are associated with recurrent stroke.
abstract: OBJECTIVE
  To determine the association between silent ischemic lesions (SILs) on baseline brain MRI and recurrent stroke in young adults with first-ever ischemic stroke.
  
  
  METHODS
  This was a single-center retrospective study of adult patients aged 18-50 years with first-ever ischemic stroke investigated by brain MRI between 2002 and 2009. Silent brain infarcts (SBIs) were defined as focal T2 hyperintensities ≥ 3 mm without corresponding focal symptoms, and leukoaraiosis was defined as focal, multifocal, or confluent hyperintensities on T2-weighted sequences. The primary outcome was recurrent stroke. A forward stepwise Cox regression model was used to determine whether SILs were independently associated with recurrent stroke.
  
  
  RESULTS
  A total of 271 eligible patients were identified in the database: 89 did not undergo MRI imaging and 12 patients had inadequate follow-up, leaving a study population of 170 patients. MRI demonstrated SILs in 48 of 170 (28.2) patients. No patients had isolated leukoaraiosis. Hypertension (p = 0.049), migraine with aura (p = 0.02), and cardiovascular disease (p = 0.04) were associated with SIL. Mean follow-up duration was 25 ± 7 months. Among patients with SILs, 11 of 48 (23%) had a recurrent stroke vs 8 of 122 (6.5%) patients without SIL (p = 0.003). After multivariate Cox regression, SILs remained independently associated with recurrent stroke (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.2-8.6, p = 0.02), as did the combination of SBIs and leukoaraiosis (HR 7.3, 95% CI 2.3-22.9, p = 0.003).
  
  
  CONCLUSIONS
  In adults ≤ 50 years old with first-ever ischemic stroke, SILs are common and independently predict recurrent stroke.
authors.affiliation: Cerebrovascular Disease Centre, Centre Hospitalier de l’Universite´ de Montre´al, Notre-Dame Hospital, Faculty of Medicine, Universite´ de Montre´al, Montre´al, Canada.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Gioia
authors.forename: Éléonore
authors.initials: É
authors.lastname: Tollard
authors.forename: Véronique
authors.initials: V
authors.lastname: Dubuc
authors.forename: Sylvain
authors.initials: S
authors.lastname: Lanthier
authors.forename: Yan
authors.initials: Y
authors.lastname: Deschaintre
authors.forename: Miguel
authors.initials: M
authors.lastname: Chagnon
authors.forename: Alexandre Y
authors.initials: AY
authors.lastname: Poppe
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000473:pathology*