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. 2013 Nov;44(11):3000-6.
doi: 10.1161/STROKEAHA.113.002227. Epub 2013 Sep 5.

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

Alessandra Del Bene  1 , Stephen D J Makin, Fergus N Doubal, Domenico Inzitari, Joanna M Wardlaw
Affiliations

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

Alessandra Del Bene et al. Stroke. 2013 Nov.

Abstract

Background and purpose: Lacunar infarction is attributable to a perforating arteriolar abnormality. Possible causes include embolism, atheromatosis, or intrinsic disease. We examined whether the size, shape, or location of the lacunar infarct varied with embolic sources, systemic atheroma, or vascular risk factors.

Methods: We examined data from 3 prospective studies of patients with clinical and diffusion-weighted imaging-positive symptomatic lacunar infarction who underwent full clinical assessment and investigation for stroke risk factors. Lacunar infarct sizes (maximum diameter; shape, oval/tubular; location, basal ganglia/centrum semiovale/brain stem) were coded blind to clinical details.

Results: Among 195 patients, 48 infarcts were tubular, 50 were 15 to 20 mm in diameter, and 97 and 74 were located in the basal ganglia and the centrum semiovale, respectively. There was no association between infarct size or shape and any of the risk factors. Centrum semiovale infarcts were less likely to have a potential relevant embolic source (4% versus 11%; odds ratio, 0.16; 95% confidence interval, 0.03-0.83) and caused a lower National Institute of Health Stroke Scale score (2 versus 3; odds ratio, 0.78; 95% confidence interval, 0.62-0.98) than basal ganglia infarcts. There were no other differences by infarct location.

Conclusions: Lacunar infarcts in the basal ganglia caused marginally severer strokes and were 3 times more likely to have a potential embolic source than those in the centrum semiovale, but the overall rate of carotid or known cardiac embolic sources (11%) was low. We found no evidence that other risk factors differed with location, size, or shape, suggesting that most lacunar infarcts share a common intrinsic arteriolar pathology.

Keywords: pathogenesis; pathology; stroke; stroke, lacunar.

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Figures

Figure 1
Figure 1
Examples of lacunar infarcts of varying size and shape: A) a tubular lacunar infarction on a coronal T1 weighted imaging (left) and axial DWI images (right), B) a small infarction in the right basal ganglia, C) a larger infarction in the right centrum semiovale.
Figure 2
Figure 2
Kernel Density plot demonstrating the distribution of lacunar infarction size by shape and location of lesion (area under the curve=1 irrespective of sample size).
Figure 3
Figure 3
Histograms of lacunar lesion size, by the present of a potential embolic source and by large vessel disease elsewhere.
See this image and copyright information in PMC

References

    1. Fisher CM. Lacunar strokes and infarcts: a review. Neurology. 1982;32:871. - PubMed
    1. Caplan LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology. 1989 Sep;39(9):1246–50. - PubMed
    1. Ryu DW, Shon YM, Kim BS, Cho AH. Conglomerated beads shape of lacunar infarcts on diffusion-weighted MRI: what does it suggest? Neurology. 2012 May 1;78(18):1416–9. - PubMed
    1. Takase K, Murai H, Tasaki R, Miyahara S, Kaneto S, Shibata M, et al. Initial MRI findings predict progressive lacunar infarction in the territory of the lenticulostriate artery. Eur Neurol. 2011;65(6):355–60. - PubMed
    1. Del Bene A, Palumbo V, Lamassa M, Saia V, Piccardi B, Inzitari D. Progressive lacunar stroke: review of mechanisms, prognostic features, and putative treatments. Int J Stroke. 2012;7(4):321–9. - PubMed

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