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Lacunar infarcts. Pathogenesis and validity of the clinical syndromes
Insights
The lacunar syndrome accurately diagnoses lacunar infarction. Cardiac and carotid embolism are unlikely causes, supporting small vessel disease as the primary cause of lacunar infarction.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- The lacunar hypothesis suggests small vessel disease causes lacunar infarction.
- Clinical diagnosis of lacunar infarction relies on specific syndromes.
Purpose of the Study:
- Validate the diagnostic accuracy of lacunar syndromes for lacunar infarction.
- Determine the frequency of cardiac versus carotid embolism sources in lacunar versus cortical infarcts.
- Compare vascular risk factors between patients with lacunar and cortical infarcts.
Main Methods:
- Prospective study of 103 patients with first-ever lacunar infarct.
- Comparison with 144 patients with first-ever cortical infarct.
- Analysis of lacunar syndrome sensitivity, specificity, and predictive values.
Main Results:
- Lacunar syndromes demonstrated high diagnostic accuracy (95% sensitivity, 93% specificity).
- Cardiac embolism (OR=0.32) and significant carotid stenosis (OR=0.35) were less frequent in lacunar infarction.
- No significant differences in vascular risk factors were observed between groups.
Conclusions:
- The lacunar syndrome is a reliable clinical tool for diagnosing lacunar infarction.
- Embolic sources (cardiac, carotid) are unlikely causes of lacunar infarction.
- Findings support the lacunar hypothesis, implicating small vessel disease.
Background And Purpose:
In this study, we investigated the lacunar hypothesis to answer three questions: 1) Is the lacunar syndrome valid for diagnosing lacunar infarction? 2) What is the frequency of potential cardiac versus carotid sources of embolism in patients with lacunar versus cortical infarct? 3) What is the frequency of vascular risk factors in these two groups of patients?
Methods:
The study was performed in a well-defined prospective series of 103 patients with a first-ever lacunar infarct and 144 other patients with a first-ever infarct involving the cortex.
Results:
Sensitivity and specificity of the lacunar syndromes in diagnosing lacunar infarction were 95% and 93%, respectively. Positive and negative predictive values of diagnosing lacunar infarction in patients with lacunar syndromes were 90% and 97%, respectively. Risk factor analysis showed no differences for either group of cerebral infarction. A cardiac source of embolism was significantly less frequent in patients with lacunar infarction (odds ratio = 0.32, 95% confidence interval = 0.17-0.61, p less than 0.001). Significant carotid stenosis (diameter reduction greater than or equal to 50%) was also less frequent in patients with lacunar infarction (odds ratio = 0.35, 95% confidence interval = 0.16-0.76, p less than 0.001).
Conclusions:
These findings show that the lacunar syndrome is an excellent clinical test for diagnosing lacunar infarction and that cardiac and carotid embolism are unlikely causes of lacunar infarction, supporting the hypothesis that lacunar infarcts are usually caused by small vessel disease.