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Risk factors and clinical manifestations of pathologically verified lacunar infarctions
M H Tuszynski1, C K Petito, D E Levy
1New York Hospital-Cornell University Medical Center, New York.
Insights
Lacunar infarctions, small strokes, are often asymptomatic. When symptomatic, they present atypically, challenging traditional understandings of lacunar syndromes and cerebrovascular disease.
Area of Science:
- Neurology
- Cerebrovascular Disease
- Pathology
Background:
- Lacunar infarctions are small ischemic strokes resulting from occlusion of deep penetrating arteries.
- Traditional understanding suggests characteristic clinical presentations for symptomatic lacunar strokes.
Observation:
- A review of 2,859 autopsy reports identified lacunar infarctions in 6% of patients.
- Analysis of 167 patients revealed common risk factors: hypertension (64%), diabetes (34%), and smoking (46%).
- Notably, 81% of patients with lacunes were asymptomatic.
Findings:
- Symptomatic lacunes most frequently presented as pure motor hemiparesis (31%), aphasia with right hemiparesis (20%), or sensorimotor dysfunction (11%).
- Pure sensory stroke was not observed as a presentation of symptomatic lacunar infarction.
- The clinical spectrum of lacunar infarction is broader and more heterogeneous than previously recognized.
Implications:
- These findings indicate that lacunar infarctions are frequently asymptomatic.
- Symptomatic presentations often deviate from classical lacunar syndromes, necessitating broader diagnostic considerations.
- This research refines the understanding of lacunar infarction's clinical manifestations and prevalence.
Abstract:
Review of 2,859 autopsy reports disclosed lacunar infarctions in 169 patients (6%). Review of the charts of 167 of these patients revealed hypertension in 64%, diabetes in 34%, smoking in 46%, and no known risk factor for cerebrovascular disease in 18%. As many as 81% of the patients with lacunes were asymptomatic. Symptomatic lacunes presented most commonly as pure motor hemiparesis (31%), aphasia plus right hemiparesis (20%), or sensorimotor dysfunction (11%); none presented as pure sensory stroke. These results suggest that the spectrum of lacunar infarction is more heterogeneous than previously thought. Most lacunes are asymptomatic, and the majority of symptomatic patients do not present with "classical" lacunar syndromes.