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Lacunar infarcts

Lacunar stroke is characterized by occlusion of a small penetrating artery creating a small deep infarct. Lacunar strokes have the lowest early recurrence risk and best survival rates, but may still cause significant functional morbidity. Although subgroup analyses are available from secondary prevention trials in lacunar stroke, few clinical trial data are available regarding nonthrombolytic antithrombotic therapy for lacunar stroke in the acute setting. [Pg.152]

Small vessel/lacunar strokes have better short- and long-term (1-year) survival as compared to other stroke subtypes. In the NINDS trial of rt-PA within 3 hours of onset, patients classified as small vessel stroke on the basis of their clinical syndrome had a 50% chance of a normal NIHSS score at 3 months if they received placebo, increasing to 70% in the treatment group. In the Lausanne cohort, 95% were independent after their first event, as opposed to only 65% of the cardioembolic strokes and 49% with large vessel atherothrombotic infarctions. Eighty-two percent of patients with small vessel stroke were independent at 1 year. Even at the time of maximal deficit, between 38% and 64% of small vessel/lacunar patients were independent, with motor impairment and extent of white matter disease adversely affecting outcomes. " In TOAST, small vessel/lacunar stroke was the only subtype associated with a favorable outcome, independent of the NIHSS score. ... [Pg.199]

Cardioembolism Cardioembolism accounts for approximately 30% of all stroke and 25-30% of strokes in the young (age <45 years)." AF accounts for a large proportion of these strokes (15-25%). Symptoms may be suggestive, but they are not diagnostic. Repetitive, stereotyped, transient ischemic attacks (TIAs) are unusual in embolic stroke. The classic presentation for cardioembolism is the sudden onset of maximal symptoms. The size of the embolic material determines, in part, the course of the embolic material. Small emboli can cause retinal ischemic or lacunar symptoms. Posterior cerebral artery territory infarcts, in particular, are often due to cardiac embolism. This predilection is not completely consistent across the various cardiac structural abnormalities that predispose to stroke, and may be due to patterns of blood flow associated with specific cardiac pathologies. [Pg.203]

Nadeau SE, Jordan JE, Mishra SK, Haerer AE. Stroke rates in patients with lacunar and large vessel cerebral infarction. J Neurol Sci 1993 114 128-137. [Pg.208]

Sacco SE, Whisnant JP, Broderick JP, Phillips SJ, O Eallon WM. Epidemiological characteristics of lacunar infarcts on a population. Stroke 1991 22(10) 1236-1241. [Pg.208]

Clavier I, Hommel M, Besson G, Noelle B, Perret JE. Long-term prognosis of symptomatic lacunar infarcts a hospital-based study. Stroke 1994 25 2005-2009. [Pg.208]

Lodder J, Boiten J. Incidence, natural history, and risk factors in lacunar infarction. Adv Neurol 1993 62 213-227. [Pg.209]

Frontal and subcortical lacunar infarcts typically affect attention, language, visuospatial function, and motor programming (Babikian et al. 1990). Compared to patients with Alzheimer s disease, those with vascular dementia show better orientation, recall, and language ability. On... [Pg.156]

Angiographic Excessive tortuosity Prior (remote) stroke Multiple lacunar infarcts Intracranial microangipathy >2 90°-bends within 5 cm of the lesion... [Pg.559]

Lacunar infarcts are typically located in the basal ganglia, the deep white matter and in the brainstem (Fisher 1965a, 1998). Depending on their location and their size circumscribed neurological symptoms will occur. C. Miller Fisher described the four classical lacunar syndromes ... [Pg.9]

Amarenco P, Hauw JJ (1990) Cerebellar infarction in the territory of the anterior and inferior cerebellar artery. A clinico-pathological study of 20 cases. Brain 113 139-155 Baquis GD, Pessin MS, Scott RM (1985) Limb shaking - a carotid TIA. Stroke 16 444-448 Barth A, Bogousslavsky J, Regli F (1994) Infarcts in the territory of the lateral branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 57 1073-1076 Baumgartner RW, Sidler C, Mosso M et al (2003) Ischemic lacunar stroke in patients with and without potential mechanism other than small-artery disease. Stroke 34 653-659... [Pg.14]

Fig. 7.9. Lacunar brain stem stroke. Typical example of a lacunar brain stem stroke that would be missed if only transverse DWI images were obtained ( DWI negative stroke ). In this case, a faint DWI lesion was seen on coronal sections at the acute time point, but both transverse and sagittal planes did not show an unequivocal lesion. PI, on the other hand, showed a clear-cut perfusion deficit in the brain stem. Follow-up images confirmed a small infarct in the brain stem. (Images were acquired in collaboration with P. Sterzer, Neurology, Frankfurt, and R. du Mesnil de Rochemont, H. Lanfermann, Neuroradiology, Frankfurt)... Fig. 7.9. Lacunar brain stem stroke. Typical example of a lacunar brain stem stroke that would be missed if only transverse DWI images were obtained ( DWI negative stroke ). In this case, a faint DWI lesion was seen on coronal sections at the acute time point, but both transverse and sagittal planes did not show an unequivocal lesion. PI, on the other hand, showed a clear-cut perfusion deficit in the brain stem. Follow-up images confirmed a small infarct in the brain stem. (Images were acquired in collaboration with P. Sterzer, Neurology, Frankfurt, and R. du Mesnil de Rochemont, H. Lanfermann, Neuroradiology, Frankfurt)...
Many individuals with LA also harbor lacunar and/or cortical infarcts. Presence of LA serves as an intermediate surrogate both for ischemic stroke and intracerebral hemorrhage as they all share similar risk factors and similar pathophysiological mechanisms (Inzitari 2003). LA is widely found in dementing illnesses, such as Alzheimer s disease, vascular dementia, and cerebral autosomal dominant arteri-opathy with subcortical infarcts and leukoencepha-lopathy (CADASIL). Failure of blood supply in the... [Pg.151]

Hassan A, Hunt BJ, O Sullivan M, Parmar K, Bamford JM, Briley D, Brown MM, Thomas DL, Markus HS (2003) Markers of endothelial dysfunction in lacunar infarction and ischemic leukoaraiosis. Brain 126 424-432 Heier LA, Bauer CJ, Schwartz L, Zimmerman RD, Morgello S, Deck MD (1989) Large Virchow-Robin spaces MR-clinical correlation. AJNR Am J Neuroradiol 10 929-936 Helenius J, Soinne L, Salonen O, Kaste M, Tatlisumak T (2002) Leukoaraiosis, ischemic stroke, and normal white matter on diffusion-weighted MRI. Stroke 33 45-50 Inzitari D (2003) Leukoaraiosis an independent risk factor for stroke Stroke 34 2067-2071... [Pg.158]

While physicians may not recognize up to 80% of lacunes (Tuszynski et al. 1989), several clinical syndromes have been correlated with relevant lacunes detected at subsequent autopsy. Five of these are regarded as the classic lacunar syndromes pure motor hemiparesis, sensorimotor stroke, pure sensory hemiparesis, dysarthria clumsy hand syndrome, and ataxic hemiparesis (Donnan et al. 2002 Fisher 1982 Bamford 2001). Pure motor stroke is the commonest lacunar syndrome in clinical practice, while pure sensory stroke is encountered less frequently. The involvement of the face, arm and leg of one side is the characteristic feature of the first three syndromes while reductions of consciousness, cognitive or visual field defects are absent. Even though lacunar infarcts have been linked to lacunar syndromes, the latter are of course not specific for this stroke subtype and mimicked by cortical infarcts, intracerebral hematomas, and non-vascular causes (Bogousslavsky et al. 1988 Bamford 2001). [Pg.198]

With the use of DWI, small acute lesions lying in different vascular territories in addition to lacunar infarction provides evidence for the possibility of an embolic mechanism in a subset of classic lacunar syndromes (Gerraty et al. 2002 Ay et al. [Pg.199]

This was systematically studied with DWI in 62 consecutive patients who presented with a classic lacunar syndrome (Ay et al. 1999). DWI showed subsidiary acute lesion(s) in addition to the index lacunar lesion in ten patients (16%). The additional lesions were punctuate and lay within the leptomen-ingeal arterial territories in the majority. Patients with subsidiary infarction(s) more frequently harbored an embolic cause of stroke. This finding is critical because underlying embolic cause may give rise to recurrent strokes with more extensive brain injury. Identification of subsidiary infarctions on DWI should have an impact in prompting the physician to introduce the best effective treatment for secondary stroke prevention in a patient with lacunar infarction. [Pg.199]

DWI promises to have tremendous value in accurately localizing the subcortical or brainstem lesion(s). A summary of studies of DWI in patients with lacunar stroke is provided in Table 13.2. It is noteworthy that there is also a group of patients with lacunar infarction who harbor multiple chronic white matter lesions on the conventional MRI and present with non-specific syndromes that could not be attributed to a specific arterial territory. Such symptoms include worsening of a preexisting dysarthria, dysphagia or ataxia, sudden appearance of emotional incontinence or recent onset bowel or bladder problems. Excellent diagnostic performance of DWI in lacunar infarctions may help to prove ischemia as the cause of non-specific neurological symptoms in such patients. [Pg.199]

Gerraty et al. (2002) 19 Clinical diagnosis of acute lacunar syndrome In 13 cases DWI and PI altered the final diagnosis of infarct pathogenesis from small perforating artery occlusion to large artery embolism... [Pg.199]

Bamford J (2001) Classical lacunar syndromes. In Bogousslavsky J, Caplan L (eds) Sreoke syndromes. Cambridge University Press, Cambridge, pp 583-589 Bamford J, Bogousslavsky J (eds) (2002) Subcortical stroke, 2nd edn. Oxford Medical Publications, Oxford, pp 27-34 Bamford J, Sandercock P, Jones L, Warlow C (1987) The natural history of lacunar infarction the Oxfordshire Community Stroke Project. Stroke 18 545-551 Benito-Leon J, Alvarez-Linera J, Porta-Etessam J (2001 Detec-tion of acute pontine infarction by diffusion-weighted MRI in capsular warning syndrome. Cerebrovasc Dis 11 350-351... [Pg.205]

Fisher CM (1982) Lacunar strokes and infarcts a review. Neurology 32 871-876... [Pg.206]

Hommel M, Besson G, Le Bas JF, Gaio JM, Poliak P, Borgel F, Perret J (1990) Prospective study of lacunar infarction using magnetic resonance imaging. Stroke 21 546-554... [Pg.206]

Tuszynski MH, Petito CK, Levy DE (1989) Risk factors and clinical manifestations of pathologically verified lacunar infarctions. Stroke 20 990-999... [Pg.208]


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See also in sourсe #XX -- [ Pg.4 , Pg.121 , Pg.151 , Pg.197 , Pg.198 , Pg.199 , Pg.209 , Pg.218 , Pg.234 ]




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