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NEW YORK (Reuters Health) - The detection of clinically silent lesions on MRI in stroke patients may indicate that another stroke is likely to occur, according to a report in the Archives of Neurology for December.

"We assume that the pathological process that causes silent lesion recurrence on MRI is the same as the process that causes clinical recurrent stroke.

MRI may depict pathologic changes before the development of clinical stroke symptoms," lead author Dr. Dong-Wha Kang, from the National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, and colleagues note.

The findings are based on a study of 120 patients with an acute ischemic stroke who underwent initial MRI within 24 hours of the event and again at day 5.

Clinical outcome data was available for 104 patients. In 68 patients, a follow-up MRI was performed up to 90 days after stroke onset. The average follow-up period was 19.3 months.

Early silent lesion recurrence was noted in 35 of 104 subjects and late recurrence was noted in 15 of 68 patients. Eight patients had a recurrent stroke, three had a transient ischemic attack, and three had vascular-related deaths.

Late silent lesion recurrence raised the risk of recurrent stroke by 6.55-fold, the report indicates. Early and late silent lesion recurrences were associated with 3.19- and 8.09-fold increased risks of the combined endpoint of recurrent stroke, transient ischemic attack, or vascular death.

Silent lesion recurrence may identify patients who should receive early aggressive stroke prevention therapy, the authors state. By reducing lesion recurrence rates in the weeks after a stroke, it may reduce the risk of stroke recurrence in the coming years, they add.

Arch Neurol 2006;63:1730-1733.