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[Lacunar syndromes due to intracerebral hemorrhage]
L Milandre1, A Donnet, N Graziani
1Services de Neurologie, CHU Timone, Marseille.
Insights
Intracerebral hemorrhage can cause lacunar syndromes, though rarely. Early CT scans are crucial for differentiating bleeding from infarction, as clinical presentation is similar.
Area of Science:
- Neurology
- Neuroradiology
Background:
- Lacunar syndromes are typically associated with ischemic stroke.
- Intracerebral hemorrhage is an uncommon cause of lacunar syndromes.
Observation:
- Nine patients with lacunar syndromes due to intracerebral hemorrhage were analyzed.
- Presentations included pure motor hemiparesis, sensorimotor stroke, ataxic hemiparesis, and dysarthria-clumsy hand syndrome.
- Risk factors included hypertension, diabetes, and anticoagulant use.
Findings:
- All cases presented with abrupt onset.
- Good recovery was observed in all patients.
- Clinical differentiation between hemorrhage and infarction was not possible.
Implications:
- Intracerebral hemorrhage should be considered in the differential diagnosis of lacunar syndromes.
- Early unenhanced computed tomography (CT) scans are essential for accurate diagnosis.
- Prompt diagnosis is critical for appropriate management and patient outcomes.
Abstract:
Nine cases (seven men and two women, mean age 64.5 years) of classical lacunar syndromes due to intracerebral hemorrhage are reported. Three patients presented with pure motor hemiparesis (two putaminal hematomas with proportional weakness and one cortical hemorrhage with brachio-crural hemiparesis). Four patients presented with sensorimotor stroke due to thalamo-capsular hemorrhage. The last two patients had thalamic hemorrhage causing ataxic hemiparesis or dysarthria-clumsy hand syndrome. Four subjects had arterial hypertension, one was diabetic, and two were treated with anti-vitamin K. Abrupt onset was noted in all instances. Only one patient experienced moderate inaugural headaches. Good recovery occurred in all cases. Lacunar syndromes are a very uncommon presentation of intracerebral bleeding. Hemorrhages are yet the second etiology of such syndromes. Distinguishing hemorrhage from infarction is not clinically possible and needs early unenhanced CT scan.