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Mechanisms in lacunar infarction.

D R Horowitz¹, S Tuhrim, J M Weinberger

¹Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029.

|March 1, 1992

Summary

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Lacunar infarction, often linked to hypertension or diabetes, frequently stems from other stroke causes like carotid and cardiac disease. Evaluating these additional factors is crucial for effective patient treatment.

Area of Science:

Neurology
Cardiovascular Medicine
Vascular Biology

Background:

Lacunar infarcts are traditionally associated with small-vessel disease, often seen in patients with hypertension or diabetes mellitus.
This study investigates alternative stroke mechanisms contributing to lacunar infarction.

Purpose of the Study:

To evaluate the significance of other stroke mechanisms beyond small-vessel disease in patients diagnosed with lacunar infarction.
To assess the prevalence of carotid and cardiac disease as potential causes of stroke in this patient group.

Main Methods:

A cohort of 108 consecutive patients with lacunar infarction in the lenticulostriate artery distribution was analyzed.
Risk factors including hypertension, diabetes mellitus, carotid artery disease, and cardiac embolic sources were evaluated.

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Main Results:

Hypertension (68%) and diabetes mellitus (37%) were prevalent, with 28% having both conditions.
Carotid artery disease was identified in 23% of patients, and 18% were at high risk for cardioembolism.
A significant proportion of patients, both with and without hypertension or diabetes, showed evidence of carotid or cardiac embolic sources (36% and 32%, respectively).

Conclusions:

The high incidence of carotid and cardiac disease in patients with lacunar infarction underscores the importance of considering these mechanisms.
Comprehensive stroke evaluation, including assessment for carotid and cardiac etiologies, is recommended for all patients with lacunar infarction, irrespective of hypertension or diabetes status.