[Clinico-anatomopathologic analysis of 25 patients with lacunar infarction]

Lacunar infarctions (LI) are associated with an excellent functional prognosis and mortality is exceptional during hospital stay. Therefore, clinico-pathological studies on LI are scarce.

A retrospective analysis was made of 50 consecutive necropsies of patients with cerebrovascular disease (CVD) from the brain archive of the Pathology Department performed from 1976 and 1985. A macroscopic and microscopic study was carried out of visualized LI which were classified in old or cystic, recent and through perivascular dilation. A clinico-pathologic evaluation was made by analyzing cerebrovascular risk factors, the associated neurological syndromes and mortality causes.

Fifty percent of brains with CVD analyzed (25 out of 50) had LI. The total of LI was 107, with a mean of 4.2 +/- 3.4 LI per brain. The main location was at the basal ganglia (54.7%), mainly the putamen (35.8%). The most common lesional diameters ranged from 1 to 4 mm (68.5%). Arterial hypertension was the main cerebrovascular risk factor (84%). Fifty-two percent of brains with LI (n = 13) were asymptomatic (clinically silent LI) Twenty-four percent had a clinical course consistent with a pseudobulbar syndrome (n = 6). Twenty percent had a pure motor hemiparesis (n = 5) and the remaining 4% had a transient ischemic attack associated with the LI topography (n = 1). Mortality causes in LI were non-neurological in nature in 88% (n = 22), whereas in non-lacunar CVD they were neurological in nature in 60% (n = 15) (p < 0,0007).

LI are usually multiple, with a small lesional diameter (from 1 to 4 mm) and clinically silent. Arterial hypertension was associated with 84% of cases and mortality causes are usually non-neurological in nature (88%).