ESOC 2026 | The management of incidental post-ischemic lesions found on neuroimaging scans

This talk was about what to do if somebody in your clinic on a scan incidentally shows a post-ischemic lesion. This happens extremely often. So, about 10% of all acquired neuroimaging shows these post-ischemic lesions. And if you go back to the patient, he wouldn’t report any symptoms of stroke or TIA in the past. And currently, it’s unclear how to handle this. We know that there is a massive prognostic impact. So, patients do have double the risk for manifest stroke and also an increased risk of dementia during follow-up. But all the therapeutic care that we do for manifest stroke is untested in this population, so we don’t know whether to start antithrombotics or what the targets for blood pressure or lipids should be. We don’t know whether we should screen for atrial fibrillation, so I mean, from pathophysiology, all of that seems reasonable. But currently, most clinics actually worldwide ignore the fact, and what we built and implemented is a referral pathway where such patients are identified and then referred to a dedicated outpatient clinic, and then counseled individually on what the best preventive measures for these patients would be.

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