Treatment of early neurological deterioration in lacunar stroke

Early neurological deterioration (END) in lacunar infarcts is a common complication, particularly during the first days of hospitalization, and still lacks a standardized therapeutic approach. This study aimed to describe the clinical presentation, predictive factors, and therapeutic strategies implemented in these cases, as well as to assess their impact on patients' functional outcomes.

We conducted a single-center, retrospective observational study including 269 patients admitted with a diagnosis of lacunar stroke between 2013 and 2023. END was defined as clinical fluctuation or progression occurring within the first five days of symptom onset. Clinical, neuroimaging, therapeutic, and functional variables were analyzed, including 90-day follow-up data. A multivariable analysis was performed to identify independent factors associated with the occurrence of END.

END occurred in 11.9% of patients. Lesions located in the internal capsule, lenticular nucleus, and the presence of a sensorimotor lacunar syndrome were identified as independent predictive factors. Dual antiplatelet therapy (aspirin and clopidogrel) and targeted hemodynamic treatment were used in most cases, with favorable clinical responses. At 90-day follow-up, 83.4% of patients achieved good functional outcomes (mRS ≤2), with low recurrence (1.9%) and mortality (0.4%).

END in lacunar stroke is a relevant clinical phenomenon. The therapeutic strategies observed may be useful; however, prospective studies are needed to evaluate novel diagnostic tools - such as biomarkers and cerebral perfusion imaging - and to assess individualized treatments that may improve outcomes in this population.