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Observational Study
. 2018 May;49(5):1183-1188.
doi: 10.1161/STROKEAHA.117.020495. Epub 2018 Mar 22.

Long-Term Morphological Changes of Symptomatic Lacunar Infarcts and Surrounding White Matter on Structural Magnetic Resonance Imaging

Caroline M J Loos  1   2   3 , Stephen D J Makin  4 , Julie Staals  1   2 , Martin S Dennis  4 , Robert J van Oostenbrugge  1   2 , Joanna M Wardlaw  5   6   7
Affiliations
Observational Study

Long-Term Morphological Changes of Symptomatic Lacunar Infarcts and Surrounding White Matter on Structural Magnetic Resonance Imaging

Caroline M J Loos et al. Stroke. 2018 May.

Abstract

Background and purpose: Insights into evolution of cerebral small vessel disease on neuroimaging might advance knowledge of the natural disease course. Data on evolution of sporadic symptomatic lacunar infarcts are limited. We investigated long-term changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging.

Methods: From 2 nonoverlapping, single-center, prospective observational stroke studies, we selected patients presenting with lacunar stroke symptoms with a recent small subcortical (lacunar) infarct on baseline structural magnetic resonance imaging and with follow-up magnetic resonance imaging available at 1 to 5 years. We assessed changes in imaging characteristics of symptomatic lacunar infarcts and surrounding white matter.

Results: We included 79 patients of whom 32 (41%) had complete and 40 (51%) had partial cavitation of the index lesion at median follow-up of 403 (range, 315-1781) days. In 42 of 79 (53%) patients, we observed a new white matter hyperintensity adjacent to the index infarct, either superior (white matter hyperintensity cap, n=17), inferior (white matter hyperintensity track, n=13), or both (n=12).

Conclusions: Half of the sporadic symptomatic lacunar infarcts developed secondary changes in superior and inferior white matter. These white matter hyperintensity caps and tracks may reflect another aspect of cerebral small vessel-related disease progression. The clinical and prognostic values remain to be determined.

Keywords: Wallerian degeneration; cerebral small vessel diseases; follow-up studies; lacunar; stroke.

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Figures

Figure 1.
Figure 1.
The occurrence of a white matter hyperintensity (WMH) cap adjacent to index lacunar lesion. A, Baseline magnetic resonance imaging (MRI), performed 1 d after stroke onset, sporadic symptomatic lacunar infarct in the right internal capsule (white arrow; fluid-attenuated inversion recovery [FLAIR]). B, Baseline FLAIR image on MRI slice superior to the index lesion. C, Follow-up MRI at 1 y (353 d) after index stroke, partial cavitated lesion (lacey-like appearance) on FLAIR (white arrow). D, Follow-up FLAIR image on MRI slice superior to the cavitated index lesion, showing a WMH cap adjacent to the index lacunar lesion (black arrow).
Figure 2.
Figure 2.
The occurrence of a white matter hyperintensity (WMH) track adjacent to index lacunar lesion. A and B, Baseline magnetic resonance imaging (MRI), performed 11 d after stroke onset, sporadic symptomatic lacunar infarct in the right pons (white arrow; fluid-attenuated inversion recovery; T2-weighted imaging). C, Follow-up MRI at 1 y (412 d) after index stroke, cavitated lacunar lesion in the right pons on T2-weighted imaging (white arrow). D, Follow-up MRI, WMH track proximal to index lacunar lesion in the right pons, visible on >2 MRI slices inferior to the index lacunar lesion (black arrow; T2-weighted imaging).
Figure 3.
Figure 3.
Patients’ recruitment characteristics. FU indicates follow-up; MRI, magnetic resonance imaging; and MSS, Mild Stroke Study.
See this image and copyright information in PMC

Comment in

References

    1. Wardlaw JM, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 2013;12:483–497. doi: 10.1016/S1474-4422(13)70060-7. - PMC - PubMed
    1. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Standards for Reporting Vascular Changes on Neuroimaging (STRIVE v1) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12:822–838. doi: 10.1016/S1474-4422(13)70124-8. - PMC - PubMed
    1. Potter GM, Doubal FN, Jackson CA, Chappell FM, Sudlow CL, Dennis MS, et al. Counting cavitating lacunes underestimates the burden of lacunar infarction. Stroke. 2010;41:267–272. doi: 10.1161/STROKEAHA.109.566307. - PubMed
    1. Koch S, McClendon MS, Bhatia R. Imaging evolution of acute lacunar infarction: leukoariosis or lacune? Neurology. 2011;77:1091–1095. doi: 10.1212/WNL.0b013e31822e1470. - PubMed
    1. Loos CM, Staals J, Wardlaw JM, van Oostenbrugge RJ. Cavitation of deep lacunar infarcts in patients with first-ever lacunar stroke: a 2-year follow-up study with MR. Stroke. 2012;43:2245–2247. doi: 10.1161/STROKEAHA.112.660076. - PubMed

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