Transient ischaemic attacks and small-vessel disease. Dutch TIA Study Group
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Updated: Jun 25, 2026
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
L J Kappelle1, J C van Latum, P J Koudstaal
1University Department of Neurology, Utrecht, Netherlands.
Insights
Transient cerebral ischemia (TCI) patients with lacunar infarcts often present with specific unilateral symptoms. This suggests lacunar TIAs may precede cortical infarcts or have a better prognosis.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Transient cerebral ischemia (TCI) is a critical neurological event.
- Distinguishing between lacunar and cortical infarcts is essential for prognosis.
- Computed tomography (CT) plays a key role in diagnosing cerebral infarcts.
Purpose of the Study:
- To investigate the relationship between patient history and infarct type in TCI.
- To determine if specific symptoms predict lacunar infarcts.
- To compare the frequency of lacunar symptoms in patients with and without visible infarcts on CT.
Main Methods:
- Retrospective analysis of clinical histories and CT scans from 606 TCI patients.
- Exclusion of posterior fossa ischemia episodes.
- Comparison of histories for patients with and without relevant infarcts on CT.
Main Results:
- 79 relevant infarcts were identified: 46 lacunar (58%) and 33 cortical.
- Lacunar symptoms had a positive predictive value of 0.74 for lacunar infarcts.
- 64% of TCI patients without infarcts on CT reported lacunar symptoms, higher than in other studies.
Conclusions:
- Lacunar symptoms are strongly associated with lacunar infarcts.
- Lacunar TIAs might have a better prognosis or precede cortical infarcts.
- Cortical infarcts may sometimes occur without preceding warning symptoms.
Abstract:
Histories and computed tomograms of 606 patients with transient cerebral ischaemia were studied. All symptoms and signs had completely resolved within 24 hours, and any episodes suggestive of posterior fossa ischaemia were excluded. Computed tomography, done after the clinical features had resolved, showed 79 relevant infarcts: 46 were small, deep, lacunar infarcts (58%, 95% confidence interval [CI] 47-69%), and 33 were larger cortical infarcts. The histories and the type of infarct in these 79 patients were compared to see whether lacunar infarcts were preceded by a history of unilateral motor or sensory symptoms without features usually attributed to the cerebral cortex. The positive predictive value of such lacunar symptoms was 0.74, with a negative predictive value of 0.61. 11 patients had a cortical infarct despite a history of lacunar TIAs, but only one occurred in the left hemisphere and speech was not affected. Of 527 patients with transient ischaemic attacks without a relevant infarct visible on computed tomography, 335 (64%) had a history suggestive of lacunar ischaemia, whereas in several other studies 20-25% of patients with ischaemic stroke have evidence of lacunar infarcts. Lacunar TIAs may therefore have a better prognosis than cortical TIAs or may often precede cortical infarcts; alternatively, many cortical infarcts may occur without warning.
