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Have I had a silent stroke?

What is a silent stroke?

A silent stroke, also known as a silent cerebral infarct, is a stroke that does not have any immediate outward symptoms and often goes undiagnosed. However, a silent stroke still causes damage to the brain and raises the risk of future strokes.

Silent strokes occur when blood flow to the brain is interrupted. This temporarily starves brain tissue of oxygen and nutrients, causing brain cells to die. However, because the areas affected are small or in “non-critical” areas of the brain, the symptoms are often not noticeable.

It’s estimated that around 13% of all strokes are silent strokes. People who have had a silent stroke are at higher risk of experiencing a major, symptomatic stroke in the future. Therefore, detecting silent strokes early is important to prevent further brain damage.

What are the causes of silent strokes?

The causes of silent strokes are similar to typical ischemic strokes that produce symptoms. The most common causes include:

– Atherosclerosis – Fatty deposits called plaque build up in the arteries, narrowing them and restricting blood flow. If a piece of plaque breaks off, it can travel in the bloodstream and block a smaller blood vessel in the brain.

– Atrial fibrillation – An irregular heartbeat that allows blood to pool and clot in the heart. These clots can travel to the brain and block blood vessels. Up to a quarter of silent strokes may be linked to atrial fibrillation.

– High blood pressure – Excessive pressure in the arteries damages blood vessel walls over time. Weakened vessels can rupture or narrow more easily, reducing blood supply. High blood pressure accounts for up to 61% of silent stroke cases.

– Diabetes – Over time, high blood sugar levels damage blood vessels. People with diabetes tend to have accelerated atherosclerosis.

– High cholesterol – Excess cholesterol in the blood contributes to plaque build-up in the arteries.

– Sleep apnea – Interrupted breathing while sleeping reduces blood oxygen levels, which stresses blood vessels. Up to 60% of people with sleep apnea experience silent strokes.

– Smoking – Chemicals in cigarette smoke damage blood vessel walls. Smokers are twice as likely to have silent strokes.

– Excess alcohol consumption – Alcohol intake stresses the cardiovascular system. People who drink heavily are more prone to silent strokes.

Who is most at risk of having a silent stroke?

While anyone can have a silent stroke, even without risk factors, some people are more likely to experience one. Those at highest risk include:

– Older adults – The risk increases significantly after age 60.

– Those with untreated high blood pressure

– People with heart disease, especially atrial fibrillation

– Those with high cholesterol

– People with diabetes

– Smokers

– Anyone who has had a previous stroke

– Those with sleep apnea

– People who abuse alcohol

– People with carotid artery disease

– African Americans – Twice as likely to experience silent strokes as Caucasians.

– Overweight or obese individuals

What are the symptoms of a silent stroke?

Silent strokes do not have any noticeable symptoms immediately after they occur. This is what makes them “silent.” However, in the days or weeks following a silent stroke, subtle symptoms may develop, including:

– Vision changes – Blurry vision or lost vision in one eye.

– Numbness – Numbness or weakness on one side of the body.

– Dizziness – A sudden sense of unsteadiness.

– Speech difficulty – Slurred speech or trouble finding words.

– Cognitive changes – Memory loss or confusion.

– Headache – A severe and sudden headache.

Keep in mind these symptoms can also occur with a mini-stroke (transient ischemic attack) or other conditions. Silent strokes are often not diagnosed until later, if at all. But getting medical help for these symptoms is still important in case you are experiencing a mini-stroke that could proceed to a full stroke.

How are silent strokes detected?

Silent strokes often go undiagnosed, as they do not produce symptoms right away. They are most often detected incidentally when tests are being done for other reasons. Some ways silent strokes might be found include:

MRI scan

An MRI scan of the brain can detect signs of silent strokes, such as small lesions, brain atrophy, and white matter disease. MRIs are often done when cognitive symptoms begin to appear and Alzheimer’s disease is suspected.

CT scan

A CT scan of the brain may pick up signs of prior silent strokes. However, MRIs are more sensitive than CT scans in detecting damage from silent strokes.


Scarring or lesions in the brain consistent with silent strokes may be found during an autopsy. Up to 28% of silent strokes are only discovered after death.

Cognitive testing

Formal testing of mental functioning may reveal subtle cognitive deficits that prompt further scanning for evidence of silent strokes.

Without scanning, silent strokes often go undiagnosed indefinitely. However, if you have any symptoms or known risk factors for stroke, talk to your doctor about getting a brain scan. Early detection allows steps to be taken to prevent further silent strokes.

What are the complications of silent strokes?

While silent strokes do not initially cause noticeable disability, they still damage brain tissue. Multiple silent strokes raise the risk of more serious health issues, including:

– Dementia – Silent strokes increase the risk of vascular dementia and Alzheimer’s.

– Movement problems – Damage to motor coordination areas may cause weakness and gait changes.

– Depression – Silent strokes in the brain’s emotional regulation areas may contribute to mood disorders.

– Full strokes – After one silent stroke, the risk of a major stroke is up to 4 times higher.

– Death – Silent strokes ultimately raise mortality risk by 50% compared to the general population.

The cognitive effects in particular accumulate over time. Having multiple silent strokes is associated with a steeper decline in memory, thinking skills, and decision making.

How are silent strokes treated?

Silent strokes themselves are only detected after the fact – they cannot be treated acutely like a major stroke. However, steps can be taken to prevent damage from silent strokes in the future.

The main treatment involves aggressively controlling any underlying risk factors with lifestyle changes and medication:

– Lowering high blood pressure – Lifestyle changes and blood pressure medications can reduce the strain on blood vessels.

– Taking blood thinners – Anticoagulants like warfarin prevent blood clots in those with atrial fibrillation.

– Lowering cholesterol – Statins and diet changes can reduce cholesterol build-up in the arteries.

– Controlling diabetes – Careful blood sugar management prevents vascular complications.

– Treating sleep apnea – Devices like CPAP machines improve breathing at night.

– Quitting smoking – Smoking cessation stops damaging blood vessels further.

– Cutting alcohol consumption – Reducing heavy drinking helps the cardiovascular system.

With treatment, the risk of silent strokes recurring or progressing to full strokes and dementia decreases. But medication and lifestyle changes need to be maintained long-term.

What is the outlook for silent strokes?

The outlook after a silent stroke depends on multiple factors:

– Number of silent strokes – The more a person accumulates, the higher their risk of dementia and disability.

– Adherence to treatment – Strict control of stroke risk factors reduces chances of progression.

– Timely follow up – Regular monitoring enables early detection of cognitive and physical changes.

– Age – Older adults see cognitive decline faster after silent strokes.

With appropriate prevention and monitoring, it’s possible to remain symptom-free for years after silent strokes. However, long-term adherence to stroke prevention is key.

Around 20% of people who have had a silent stroke will go on to have a major stroke within 5 years without adequate treatment. But taking quick preventive action allows most people with silent strokes to maintain their quality of life.

Should I be screened for silent strokes?

There are currently no medical guidelines recommending screening for silent strokes in people without symptoms. This is because there is no conclusive evidence that early detection improves outcomes.

However, some experts argue that certain high risk groups would benefit from screening based on factors like:

– Age – Screening over age 65 may detect issues earlier in vulnerable populations.

– Medical history – Those with multiple stroke risk factors may warrant screening.

– Family history – Individuals with many family members affected by stroke or dementia could be screened.

– Noticeable changes – Screening when mental decline or physical changes appear may allow earlier intervention.

Talk to your doctor about whether screening might be advisable if you are concerned. An MRI scan is the most accurate, non-invasive way to detect evidence of silent strokes.

Ultimately, focusing on preventing silent strokes by controlling your stroke risk factors provides the most benefit whether you choose to screen or not.

Can silent strokes be prevented?

While you cannot guarantee that you won’t have a silent stroke, you can significantly reduce your risk through preventive measures:

– Lower blood pressure – Maintain a reading below 120/80 mmHg through lifestyle and medication.

– Treat atrial fibrillation – Work with your doctor to prevent blood clots.

– Improve cholesterol – Keep total cholesterol under 200 mg/dL.

– Control blood sugar – Keep Hba1C levels for diabetes under 7%.

– Lose weight – Achieve and maintain a healthy BMI.

– Eat healthy – Follow a heart-healthy diet lower in salt, fat and refined carbohydrates.

– Stay active – Get 2.5 to 5 hours of moderate activity per week.

– Limit alcohol – Stick to 1 drink or less per day maximum.

– Don’t smoke – If you smoke, get help quitting as soon as possible.

– Treat sleep apnea – Use devices as prescribed to improve sleep quality.

– Reduce stress – Use relaxation techniques and maintain a balanced lifestyle.

– Take medications as prescribed – Stay on track with medications for stroke prevention.

Taking proactive measures offers the best chance of avoiding silent strokes and further vascular damage. Take steps now to protect your brain health.


Silent strokes are more common than realized, affecting up to 1 in 5 older adults. While they do not initially cause noticeable symptoms, silent strokes raise the risk of cognitive decline, physical disability and future strokes down the line.

Prompt detection and preventive treatment are key to stopping silent strokes from accumulating and progressing to a major stroke or dementia. Controlling underlying stroke risk factors offers the best protection against the lasting consequences of silent strokes on the brain.

If you experience any subtle neurological symptoms or have multiple stroke risk factors, don’t wait to get checked out. Early detection of silent strokes allows interventions to prevent long-term impacts on brain health and quality of life. With a combination of screening when appropriate, therapeutic lifestyle changes and careful monitoring, most people can avoid disability after a silent stroke.