Silent New Brain Lesions: Innocent Bystander or Guilty Party?

Eun-Jae Lee, Dong-Wha Kang, Steven Warach, Eun-Jae Lee, Dong-Wha Kang, Steven Warach

Abstract

With the advances in magnetic resonance imaging, previously unrecognized small brain lesions, which are mostly asymptomatic, have been increasingly detected. Diffusion-weighted imaging can identify small ischemic strokes, while gradient echo T2* imaging and susceptibility-weighted imaging can reveal tiny hemorrhagic strokes (microbleeds). In this article, we review silent brain lesions appearing soon after acute stroke events, including silent new ischemic lesions and microbleeds appearing 1) after acute ischemic stroke and 2) after acute intracerebral hemorrhage. Moreover, we briefly discuss the clinical implications of these silent new brain lesions.

Keywords: New ischemic lesions; New microbleeds; Silent brain lesions.

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Early local silent new ischemic lesions (SNILs). Acute diffusion-weighted imaging (DWI) was performed within 24 hours after symptom onset and follow-up DWI was performed 2 days after the index ischemic stroke. Early local SNILs (arrows) are shown on the follow-up DWI.
Figure 2.
Figure 2.
Early distant silent new ischemic lesions (SNILs). Acute diffusion-weighted imaging (DWI) and perfusion-weighted imaging were performed within 24 hours after symptom onset. Follow-up DWI was performed 8 days after the index ischemic stroke. Early distant SNILs (arrows) are indicated on the follow-up DWI.
Figure 3.
Figure 3.
Pathophysiology and clinical implications of silent new ischemic lesions (SNILs) after stroke. CPP, cerebral perfusion pressure; ICH, intracerebral hemorrhage; SVD, small vessel disease.
Figure 4.
Figure 4.
Early silent new ischemic lesions (arrows) coexisting with acute intracerebral hemorrhage in the left basal ganglion. Magnetic resonance imaging was performed 2 days after symptom onset.

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