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Are hypertension or cardiac embolism likely causes of lacunar infarction?
J Lodder1, J M Bamford, P A Sandercock
1Department of Neurology, University Hospital Maastricht, The Netherlands.
Insights
Hypertension is not more common in lacunar infarction patients than in other stroke types. Cardioembolic causes are also less frequent in lacunar infarction, challenging previous assumptions about stroke etiology.
Area of Science:
- Neurology
- Cardiology
- Stroke Medicine
Background:
- Lacunar infarction is a common type of stroke.
- The precise etiological factors for lacunar infarction remain debated.
- Previous hypotheses suggested hypertension as a primary driver and cardioembolism as a less common cause.
Purpose of the Study:
- To test the hypothesis that hypertension is more prevalent and cardiac embolism less common in lacunar infarction compared to other cerebral infarcts.
- To compare risk factor profiles between patients with lacunar infarcts and those with carotid artery-distribution infarcts.
Main Methods:
- A comparative study of 102 lacunar infarct patients and 202 carotid artery-distribution infarct patients.
- Analysis of prestroke hypertension prevalence and markers of sustained hypertension.
- Assessment of common ischemic stroke risk factors including atrial fibrillation and myocardial infarction.
Main Results:
- No significant difference in prestroke hypertension prevalence or sustained hypertension markers between the two groups.
- Atrial fibrillation and recent myocardial infarction were more common in carotid artery-distribution infarcts.
- No significant differences in other risk factors like TIA, diabetes, or smoking.
Conclusions:
- Hypertension is not a more significant factor in lacunar infarction than in other atherosclerotic ischemic strokes.
- Cardioembolic occlusion is an infrequent cause of lacunar infarction, supporting existing autopsy findings.
Abstract:
We tested the hypothesis that hypertension is more common and cardiac embolism less common in patients with lacunar infarction than in patients with other types of cerebral infarction. We studied risk factor profiles in a series of 102 consecutive patients with a lacunar infarct and 202 consecutive patients with a carotid artery-distribution infarct involving the cortex registered in the Oxfordshire Community Stroke Project, a community-based study of first-ever stroke. The two groups did not differ in the prevalence of prestroke hypertension (defined in a number of ways) or in the prevalence of markers of sustained hypertension. The presence of atrial fibrillation and a history of myocardial infarction, particularly during the 6 weeks before the stroke, were significantly more common in the group with carotid-distribution infarcts involving the cortex. There was no significant difference in the prevalence of other accepted risk factors for ischemic stroke, including previous transient ischemic attack, cervical bruit, diabetes mellitus, peripheral vascular disease, or cigarette smoking. Our results suggest that hypertension is no more important in the development of lacunar infarction than it is in the development of other types of ischemic stroke that are presumed to be due to atherosclerotic thromboembolism in a major cerebral artery. Our data support the autopsy evidence that cardioembolic occlusion is an unusual cause of lacunar infarction.