Related Experiment Videos
Mechanisms in lacunar infarction
D R Horowitz1, S Tuhrim, J M Weinberger
1Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029.
Insights
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.
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.
Background And Purpose:
Lacunes are thought to occur in patients with hypertension or diabetes mellitus as a result of small-vessel disease. This study evaluated the importance of other stroke mechanisms in a population of patients with lacunar infarction.
Methods:
We evaluated 108 consecutive patients with a lacune in the lenticulostriate distribution for other stroke risk factors such as carotid and cardiac disease.
Results:
Hypertension was present in 68% of the patients and diabetes mellitus in 37%; both occurred in 28% and neither occurred in 23%. Noninvasive carotid studies identified atherosclerotic plaque as a possible embolic source in 23%. By previously established criteria, 18% were at high risk for cardioembolism. Of those with hypertension or diabetes mellitus, 36% were at risk for a carotid or cardiac embolus. Of those without hypertension or diabetes mellitus, 32% had a possible carotid or cardiac etiology.
Conclusions:
The high incidence of carotid and cardiac disease in those with and without hypertension or diabetes mellitus suggests the importance of other stroke mechanisms in this population. Patients with lacunar infarction should therefore be evaluated for other causes of stroke that may be treatable.