Objective To investigate the relationship between silent brain infarction (SBI) and first-event ischemic stroke (FEIS). Methods A consecutive series of 115 FEIS patients admitted to our hospital who had underwent MRI were included in this retrospective，single center study. Clinical features were comparedbetween patents with and without SBI. The infarcts distribution of SBI and FEIS patients were analyzed.Whether SBI was a potential influence factor of the severity of FEIS was studied. Results Hypertension andcardiovascular diseases were more common in FEIS accompanied with SBI patients. The distribution concordance of infarcts between SBI and FEIS patients did not influence the severity of FEIS. But patients with more SBIshowed larger infarcts of FEIS. Conclusions SBI is associated with FEIS. Patients with more SBI show more severe clinical symptoms with larger infarcts of FEIS.