INCIDENTALLY DISCOVERED STROKE LESIONS IN PATIENTS WITH DEMENTIA

초록

Background and Aims: The elderly patients with dementia may also have vascular risk factors, which make them vulnerable to stroke. We report cases of stroke discovered incidentally in patients with dementic illness. Methods: Between January 2023 and March 2025, we enrolled cases with incidental stroke lesions who underwent Brain MRI during routine dementia evaluations. Demographic, clinical and radiological findings on MRI were reviewed. The presence of vascular risk factors, stroke subtypes, severity of dementia, diagnosis of dementic illness were investigated. Descriptive analysis was performed. Results: A total of 10 patients were enrolled in this study. Mean age was 79 and 5 were male. Regarding the diagnosis of dementic illness, 7 patients had mild cognitive impairment or dementia due to Alzheimer’s disease (AD), and 3 had vascular cognitive impairment. In 7 patients, amyloid PET-CT were performed for dementia evaluation. The MRI showed tiny acute ischemic infarct in a single vascular territory in 4 patients, tiny acute ischemic infarcts in multiple vascular territories in 5 and cortical superficial siderosis in one. The TOAST subtypes were cardioembolism in one, small vessel occlusion in two, cryptogenic in two, other causes in two, undetermined due to incomplete stroke work-up in 3. All had more than one vascular risk factors. However, there was not any clinical symptom which is relevant to the stroke lesion. Conclusions: Silent stroke lesions could be incidentally discovered during dementia evaluations. The lesions were small and mostly located in multiple vascular territories. For those dementia patients with incidental stroke, stroke etiologic documentation and secondary stroke preventions are required.