Background: The susceptibility-weighted imaging (SWI) is an essential MRI sequence in the assessment of acute ischemic stroke. Silent cerebrovascular disease is five times more prevalent than symptomatic brain infarcts and is associated with future risk for stroke and dementia. Objectives: Evaluation of the diagnostic performance of susceptibility-weighted magnetic resonance sequence imaging (SWI) for early diagnosis of silent brain infarction (SBI) in apparently neurologically-free patients presented by transient neurological manifestations. Patients and Methods: The study included 218 patients who were clinically evaluated for demographic, clinical data concerning presence of chronic medical diseases, presenting symptoms and its frequency and severity. Routine lab investigations and lipid profile were performed and the plasma atherogenic index (PAI) for oncoming cardiovascular insults was calculated. MRI scan was performed using 1.5 T MRI scanner (Toshiba Vantage) with a head coil. Results: 102 patients (46.8%) had chronic medical diseases and hypertension (HTN) and diabetes mellitus (DM) are the most common. The commonest complaint was occasional amnesia, slurred speech and weak handgrip. PAI defined 53 patients at high, 101 patients at intermediate and 64 patients at low risk of cardiovascular insults. Susceptibility vein sign (SVS)+ were detected in 78 SWI scans and showed positive significant correlation with smoking, multiple co-morbidities, presence of chronic kidney disease, DM, hypertension and with PAI. Conclusion: The presence of SVS in SWI during MRI examination is pathognomonic sign for the presence of SBI. The incidence of SBI on SWI scans of apparently neurologically free patients who presented by transient neurological manifestations is high and was found to be associated with the presence of chronic medical diseases especially in obese dyslipidemic patients.