Asymptomatic Cerebrovascular Disease and Systemic Diagnosis in Stroke, Atherothrombosis as a Disease of the Vascular Tree

Atherosclerosis is a chronic vascular disease of true epidemic proportions. It is the first cause of death in developed countries and responsible for one quarter of documented deaths worldwide. Arteriosclerotic vascular disease is a systemic process which affects different organs; principally the heart, brain, and peripheral artery system. Despite well-documented differences, all manifestations of the disease share the same risk factors; albeit with varying degrees of impact. The concept of asymptomatic cerebrovascular disease is an important one for clinicians who treat stroke patients. The development of new neuroimaging and vascular evaluation techniques has enabled the presence of apparently silent lesions to be detected and their progress monitored in follow-up. Ultrasonography techniques enable the identification of atheromatous disease. Asymptomatic involvement of the cerebral parenchyma consists of ischemia, leukoaraiosis, and silent hemorrhage and can be detected using the available radiological techniques such as cranial CT, magnetic resonance, or gradient echo magnetic resonance imaging. From the point of view of prevention, it is of considerable importance to identify diagnostic markers for arteriosclerosis in asymptomatic patients in some, if not all, vascular territories. In view of the natural history of this disease and the impact it has on society, there is an increasing need to identify and understand the risk factors or vascular disease risk markers, so that the stratification of risk of an individual patient or in a specific population can be established, appropriate cerebrovascular assessments conducted, and appropriate therapeutic intervention initiated.