Pure motor stroke: a reappraisal

Area of Science:

• Neurology
• Stroke Medicine
• Neuroimaging

Background:

• Isolated hemiparesis is a common stroke presentation.
• Determining the stroke's etiology and lesion topography is crucial for effective treatment.
• Previous studies have not fully elucidated the relationship between specific hemiparetic patterns and underlying stroke pathology.

Purpose of the Study:

• To investigate the correlations between patterns of hemiparetic weakness, stroke type, lesion topography, and etiology.
• To identify factors predicting deep infarcts in patients with isolated hemiparesis.
• To refine diagnostic criteria for lacunar stroke based on clinical presentation.

Main Methods:

• Retrospective analysis of 255 patients with first-ever isolated hemiparesis.
• Classification of weakness distribution: face, upper limb, and lower limb (FUL); face and upper limb (FU); upper limb (U); upper and lower limb (UL).
• Logistic regression analysis to identify predictors of lesion localization and etiology, considering hypertension and weakness patterns.

Main Results:

• FUL weakness pattern was most common (50%), followed by FU (29%).
• Hypertension and FUL weakness distribution significantly predicted deep infarcts (90% probability).
• Patients with FUL weakness and no hypertension, or UL weakness and hypertension, had a 70% probability of deep infarct.

Conclusions:

• Weakness pattern and hypertension history are strong predictors of lesion localization in hemiparetic stroke.
• The assumption of lacunar etiology for pure motor stroke should be cautiously applied, primarily to patients with FUL involvement.
• This study refines the clinical approach to diagnosing stroke etiology based on hemiparesis patterns.