Silent cerebral infarction: Not so silent after all

The occurrence of large cerebral infarctions due to sickle cell disease (SCD) has been known for many years, but it was not until 1988 that brain MRI documented 7 lesions consistent with subclinical infarction in 6 children with SCD who had experienced no prior signs or symptoms of stroke.1 Five of these 6 children had T2 hyperintensity abnormalities located in border zone regions. Such lesions were eventually characterized as a silent cerebral infarction (SCI). The presence of SCIs predicts both future SCIs and overt stroke.2