Background: The significance of silent infarcts (SIs) is unknown in very elderly patients with first-ever acute ischemic stroke.
Methods: Fifty patients aged 80 years and older with first-ever acute ischemic stroke were studied. The conventional risk factors for stroke, the scores of age-related white matter changes, and the findings on echocardiography were compared between patients with and without SIs.
Results: Thirty-eight patients (76%) had one or more SIs. The patients without SIs frequently had atrial fibrillation (50% vs. 13.2%, p = 0.014) or spontaneous echo contrast or thrombi on echocardiography (57.1% vs. 0%, p = 0.026) and showed lower scores on age-related white matter changes (0.5 +/- 0.67 vs. 1.13 +/- 0.58, p = 0.002) than did patients with SIs. There were no differences in other risk factors for stroke between the two groups.
Conclusion: In patients aged 80 years and older, the absence of SIs with a first-ever acute ischemic stroke may suggest the presence of cardiac embolic sources or atrial fibrillation.