Small vessel infarcts

I had a vey minor stroke last June. (retional Emboli that washed out in about a month).The MRI revealed "a multidude of high intensity white matter lesions, bilaterally from centrumsemiovale to apex, in frontal,parietal(extending to gray matter),and occipital lobes".  Does this make me at possible risk of any kind of dementia or Alz.D.? I am 67, 120 lbs,very active,my only risk factor is/was smoking. I am on aspirin 150mg daily and Coumadin 52&1/2 mg weekly to maintain between 2./3.INR.

[CCF Neuro[P] MD, RPS]

Dear Neoma:

I am very sorry to hear about your multiple infarct.  Yes, multiple infarcts of small vessels can increase your chances having earlier onset dementia.  Since your only risk factor is smoking, I would recommend that you stop (I am sure this has already been told to you).  If smoking is the only risk factor then why are you on coumadin?  We tend to use coumadin for heart related risk factors (i.e. Atrial fibrillation) and intracranial disease (i.e. stenosis).  Do you have a heart problem such as AF or patent foramen ovale with a right to left shunt?  What is lipid profile, high cholesterol?  What about your blood pressure, is it high?  We tend to associate small vessel disease with Hypertension, or high cholestrol/lipids such as in non-insulin or insulin dependent diabetes.  But to answer your question, yes multiple infarcts is assoicated with earlier dementia.  This does not mean that you will have early onset dementia however.  We all tend to get hyperintense areas on our MRI just from ageing (aging).  One needs to always try and figure out if these areas are from ageing (aging) or are they from small infarcts.  You seem to have been told that yours are from infarcts.

Sincerely,

CCF Neuro MD

[Neoma Barnett]

Thank You!
In response to your questions;The carotid ultrasound indicated (i was told) was<50%. Cholesterol-normal,No heart problems,blood pressure is always within normal range.No significant health problems!
I'm on Coumadin/asprin for stroke prevention(?). I was told that I have been having these "silent " strokes for possibly 10years and that was the reason for the infarcts and I was high risk for a severe stroke.
I live in rather remote area where adequate medical help is limited.
Thank you again!! Neoma

[Neoma Barnett]

The MRI report also reads "These high intensity white matter lesions are consistent with small vessel infarcts" Does that mean "silent" strokes?
I am also concerned about the coumadin/aspirin. My INR level has fluctuated from 2.9-1.5. Recently it has been falling and I have been increased (Coumadin)to 52&1/2 mg weekly which seems like a high dose to me. My nurse tells me not to worry,it's normal for that to happen.I've read extensively about Coumadin so I pretty much know what affects it and I AM a compliant patient!I just don't understand.

[arrowflynn]

A related discussion, Help me understand please was started.