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Clinical pearl: few patients have been informed of an accidental cerebral infarction… : Emergency medicine news


cerebral infarction, cerebral imaging, cerebrovascular accident


Hidden cerebral infarcts are focal lesions detected on brain imaging consistent with ischemia in the absence of a history of overt stroke or neurological dysfunction. These infarcts are the most common incidental finding in brain imaging and are associated with an increased risk of future stroke. (Ann Emergency Med. 2022;79[3]:265;; Caress. 2017;48[2]:e44;

Stroke prevention interventions, such as additional diagnostic testing and risk factor modification, are indicated in these patients, according to current guidelines. (Ann Emergency Med. 2022;79[3]:265;; Caress. 2017;48[2]:e44;

Hidden cerebral infarction is a common incidental finding in elderly emergency room patients, but such a finding is often not conveyed to the patient. (Caress. 2020;51[8]:2597; As a result, primary stroke prevention strategies are rarely implemented despite growing evidence that hidden strokes are associated with subsequent strokes, dementia, and myocardial infarction. (Ann Emergency Med. 2022;79[3]:265;

A recent study found that the prevalence of hidden strokes in patients over the age of 50 was 11% in more than 800 patients who underwent head CT and were discharged from the emergency room. (Ann Emergency Med. 2022;79[3]:265; Only nine percent of those patients were made aware of the discovery.

PEs should inform the patient of the incidental finding of a hidden cerebral infarction, document that the patient was informed, and refer the patient for additional testing and risk factor modification, if appropriate. Since silent strokes are associated with future risk of symptomatic stroke independent of other vascular risk factors, such a practice may affect the future health of the patient and reduce the risk of clinician liability.

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