High frequency of silent brain infarcts associated with cognitive deficits in an economically disadvantaged population

OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.

Etiology of young adult onset brain infarction in Iran

Stroke in young adults causes morbidity in this socioeconomically-active age group. Etiologic frequency of ischemic stroke in young adults is different around the world. This study was conducted to determine the causes of stroke in Iranian young adults. The study population consisted of 314,000 young adult residents in the Southern Khorasan Province, East of Iran. All the patients with stroke, admitted to Vali-e-Asr Tertiary Care Hospital, entered this study. Demographic data, clinical presentation, and investigations of consecutive patients aged 15 - 45 years, presented with ischemic stroke, were registered in Southern Khorasan Stroke Database between 2000 and 2005. All the patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Etiologic classification of stroke in the patients was made based on the Practical Iranian Criteria. One hundred and twenty-four patients [60 females and 64 males] were prospectively investigated during a 5-year period. The incidence of ischemic stroke in young adults was 8/100,000 per year. Cardioembolic mechanism constituted 54% of all stroke etiologies in young adults. Rheumatic valvular heart disease was present in 32% of the patients and caused 2.5 preventable stroke cases per 100,000 young adults per year. Rheumatic valvular heart disease is the most common cause and a preventable etiology of stroke in Iranian young adults

Migrainous infarct: an update

Migraine and stroke have been linked in a complex bi-directional association, though there are quite a few pathophysiological pieces to be found to complete the puzzle. International Classification of Headache Disorders-11 [ICHD-II] has defined a specific term 'migrainous infarct' that can be the crucial link between the two disorders. The authors review the latest developments related to migrainous infarct and present a compilation of case reports from 1988 to 2006