To clarify whether silent cortical strokes (SCS) could be a predictor
of symptomatic stroke in patients with atrial fibrillation (AF), 72 pa
tients with AF (50 with chronic AF, 22 with paroxysmal AF) were studie
d. Patients with mitral stenosis, history of myocardial infarction, or
dilated cardiomyopathy were excluded from this study. Using cranial m
agnetic resonance imaging (MRI), the patients were divided into those
with SCS (23 patients, Group 1) and those without SCS (49 patients, Gr
oup 2). The incidence of symptomatic stroke was then compared between
the two groups. Three patients (13%) in Group 1 developed symptomatic
brain infarction; this is statistically significant (p < 0.05), compar
ed with the patients in Group 2, none of whom experienced symptomatic
stroke. We suggest that SCS is a predictor of symptomatic cerebral inf
arct in patients with AF. Therefore, it is thought to be important to
diagnose SCS using cranial MRI or computed tomography and to keep pati
ents with SCS under close surveillance.