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Hemorrhagic lacunar stroke
A Arboix1, L García-Eroles, J Massons
1Acute Stroke Unit, Department of Neurology, Hospital del Sagrat Cor, Barcelona, Spain. aarboixd@meditex.es
Insights
Hemorrhagic lacunar stroke, a rare cause of stroke, is characterized by sudden onset, headache, and absence of dysarthria. These clinical features help distinguish it from other lacunar stroke types.
Area of Science:
- Neurology
- Stroke Medicine
- Neuroimaging
Background:
- Lacunar strokes are small ischemic or hemorrhagic infarcts in the deep brain structures.
- Hemorrhagic lacunar stroke is a less common subtype, often presenting with overlapping symptoms with other stroke types.
- Accurate differentiation of hemorrhagic lacunar stroke is crucial for appropriate management.
Purpose of the Study:
- To identify clinical and neuroimaging predictors differentiating hemorrhagic lacunar stroke from non-hemorrhagic lacunar stroke and non-lacunar intracerebral hemorrhage.
- To assess the frequency of hemorrhagic lacunar stroke within a prospective stroke registry.
Main Methods:
- Retrospective analysis of 17 patients with hemorrhagic lacunar stroke from a prospective stroke registry.
- Comparison of demographic, anamnestic, clinical, and neuroimaging variables between hemorrhagic lacunar stroke, non-lacunar intracerebral hemorrhage, and non-hemorrhagic lacunar stroke groups.
- Logistic regression analysis to identify independent predictors of hemorrhagic lacunar stroke.
Main Results:
- Hemorrhagic lacunar stroke constituted 3.8% of lacunar syndromes and 7.4% of intracerebral hemorrhages in the registry.
- Compared to non-lacunar hemorrhage, hemorrhagic lacunar stroke showed higher rates of hypertension, smoking, and internal capsule involvement.
- Key predictors for hemorrhagic lacunar stroke included headache (OR 10.14), sudden onset (OR 9.89), and absence of dysarthria (OR 0.10).
Conclusions:
- Headache, sudden symptom onset, and lack of dysarthria are significant indicators for diagnosing hemorrhagic lacunar stroke.
- These clinical findings aid in distinguishing hemorrhagic lacunar stroke from other stroke etiologies.
- Further research can refine diagnostic criteria and improve patient outcomes.
Abstract:
A total of 17 patients with lacunar syndromes due to intracerebral hemorrhage or hemorrhagic lacunar stroke (pure motor hemiparesis 9, sensorimotor stroke 5, pure sensory stroke 3) are reported. Data from these patients were obtained from consecutive stroke patients included in the prospective Hospital Sagrat Cor-Aliança Stroke Registry. Hemorrhagic lacunar stroke accounted for 3.8% of all cases of lacunar syndrome (n = 439) and 7.4% of all cases of intracerebral hemorrhage (n = 229) entered in the database. Demographic, anamnestic, clinical and neuroimaging variables in patients with hemorrhagic lacunar stroke, non-lacunar intracerebral hemorrhage and non-hemorrhagic lacunar stroke were compared. Predictors of hemorrhagic lacunar stroke were assessed by logistic regression analysis. Hypertension, cigarette smoking and involvement of the internal capsule were significantly more frequent in patients with hemorrhagic lacunar stroke than in those with non-lacunar intracerebral hemorrhage, whereas nausea and vomiting, altered consciousness, speech disturbances, hemianopia, and ventricular hemorrhage were significantly less frequent. As compared with non-hemorrhagic lacunar stroke, patients with hemorrhagic lacunar stroke were more likely to have hypertension, sudden stroke onset (minutes), head injury, headache, and basal ganglia involvement and less likely to have diabetes, gradual stroke onset (hours), and dysarthria. After multivariate analysis, only headache (OR 10.14), sudden onset (OR 9.89), and dysarthria (OR 0.10) were independent predictors of hemorrhagic lacunar stroke. Accordingly, the presence of headache and sudden onset of symptoms and absence of dysarthria may be useful signs for distinguishing hemorrhagic lacunar stroke from other causes of lacunar stroke.