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Variation in risk factors for recent small subcortical infarcts with infarct size, shape, and location

Alessandra Del Bene1, Stephen D J Makin, Fergus N Doubal

  • 1From the NEUROFARBA Department, Neuroscience Section, University of Florence, Italy (A.D.B., D.I.); and Divisions of Neuroimaging Sciences (S.D.J.M., J.M.W.) and Geriatric Medicine (F.N.D.), Western General Hospital, University of Edinburgh, Edinburgh, UK.

Stroke
|September 7, 2013
PubMed

Insights

Lacunar infarcts in the basal ganglia are linked to more severe strokes and embolic sources compared to the centrum semiovale. Most lacunar infarcts likely stem from intrinsic arteriolar disease, regardless of size or shape.

Area of Science:

  • Neurology
  • Cerebrovascular Diseases
  • Stroke Etiology

Background:

  • Lacunar infarction results from small vessel disease affecting perforating arterioles.
  • Potential causes include embolism, atheromatosis, or intrinsic arteriolar pathology.
  • Understanding variations in infarct characteristics based on etiology is crucial.

Purpose of the Study:

  • To investigate if lacunar infarct size, shape, or location correlate with embolic sources, systemic atheroma, or vascular risk factors.
  • To differentiate potential underlying pathologies of lacunar infarction.

Main Methods:

  • Analysis of data from 3 prospective studies of symptomatic lacunar infarction patients.
  • Clinical assessment and stroke risk factor evaluation.
  • Blind coding of infarct size (maximum diameter), shape (oval/tubular), and location (basal ganglia/centrum semiovale/brain stem).

Main Results:

  • No association found between infarct size/shape and vascular risk factors.
  • Centrum semiovale infarcts were less likely to have embolic sources (4% vs. 11%) and resulted in lower NIH Stroke Scale scores (2 vs. 3) compared to basal ganglia infarcts.
  • Basal ganglia infarcts were associated with marginally severer strokes and a higher likelihood of embolic source.

Conclusions:

  • Lacunar infarcts in the basal ganglia are associated with more severe strokes and a higher potential for embolic origin than those in the centrum semiovale.
  • The overall rate of identified embolic sources (carotid or cardiac) was low (11%).
  • Findings suggest a common intrinsic arteriolar pathology for most lacunar infarcts, irrespective of location, size, or shape.
Abstract

Keywords:
pathogenesispathologystrokestroke, lacunar

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