Computed tomographic changes in lacunar syndromes

Area of Science:

• Neurology
• Radiology
• Stroke Medicine

Background:

• Lacunar syndromes (LACS) result from small deep infarcts with variable clinical presentations and outcomes.
• Prognostic indicators for LACS are crucial for patient management and treatment strategies.

Purpose of the Study:

• To investigate the prognostic value of serial computed tomographic (CT) scans in patients diagnosed with lacunar syndrome (LACS).
• To compare changes in lacune size and characteristics on CT scans between patients with different functional outcomes at 3 months.

Main Methods:

• 32 patients with first-ever stroke diagnosed as LACS underwent non-contrast CT scans on day 3 and day 10 post-symptom onset.
• Lacunes were identified, and their size and X-ray attenuation were assessed for changes between scans.
• Patients were categorized into independent (modified Rankin scale 0-2) and handicapped (modified Rankin scale 3-5) groups at 3 months.

Main Results:

• Patients with poorer outcomes were older, more impaired on admission, and had more cardiac issues and cognitive decline.
• Leukoaraiosis was more prevalent in the handicapped group.
• While average lacune size on day 3 and 10 was not significantly different between groups overall, smaller lacunes that decreased in size from day 3 to 10 were associated with independence.

Conclusions:

• Patient age, cognitive and cardiac status, and leukoaraiosis presence are factors influencing LACS outcome.
• The size and changes in size of the symptomatic lacune on serial CT scans are significant prognostic indicators for lacunar syndrome recovery.