Long-term prognosis of symptomatic lacunar infarcts. A hospital-based study

This study concerns the long-term prognosis of lacunar infarcts.

We report the analysis of our hospital-based series of 178 patients consecutively admitted for a lacunar syndrome due to a lacunar infarct diagnosed with computed tomography and magnetic resonance imaging. Demographic data, medical history, vascular risk factors, and imaging data were recorded for each patient. The follow-up was 35 +/- 22 months.

The lacunar syndrome was pure motor hemiparesis in 69 patients (39%), ataxic hemiparesis in 45 patients (25.4%), pure sensory stroke in 15 patients (8.5%), sensorimotor stroke in 14 patients (7.9%), and miscellaneous syndrome in 34 patients (19.2%). The 4-year survival rate was 80 +/- 4% and the 4-year survival rate without recurrent stroke was 85 +/- 3.5%. Using Cox proportional-hazards analysis, the predictors of death were age (P < .02), diabetes mellitus (P < .05), and cigarette smoking (P < .05). We did not find any predictors of recurrence. After 1 year, 74% of the patients had mild or no disability. Using logistic regression analysis, the predictive factors of disability were age more than 70 years (P < .01), diabetes (P < .01), history of stroke or transient ischemic attack (P < .05), and type of lacunar syndrome (P < .01). Imaging data, number of lacunes, and presence of leukoaraiosis were not predictors of outcome.

Our study suggests that with a high survival rate, a low recurrence rate, and a relatively good functional recovery, lacunar infarcts have a relatively favorable prognosis.