Document Detail

Clinical diagnosis of lacunar stroke in the first 6 hours after symptom onset: analysis of data from the glycine antagonist in neuroprotection (GAIN) Americas trial.
MedLine Citation:
PMID:  17717313     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Although the pathophysiological heterogeneity of stroke may be highly relevant to the development of acute-phase therapies, discriminating between ischemic stroke subtypes soon after onset remains a challenge. We conducted a study of the accuracy of a clinical diagnosis of lacunar stroke in the first 6 hours after symptom onset.
METHODS: We analyzed data from 1367 patients in the Glycine Antagonist In Neuroprotection (GAIN) Americas trial. The Trial of ORG10172 in Acute Stroke Treatment (TOAST) category "small vessel (lacunar)" disease at day 7 or at hospital discharge was used as the reference standard to determine the accuracy of a diagnosis of a lacunar stroke made within 6 hours of symptom onset using the Oxfordshire Community Stroke Project (OCSP) classification "LACS." Outcome was analyzed by comparing the proportions of patients classified as "LACS" at baseline or "small vessel (lacunar)" at 7 days who were dead or dependent at 3 months.
RESULTS: The positive predictive value of an OCSP diagnosis of a lacunar stroke was 76% (95% CI: 69% to 81%; sensitivity 64% [95% CI: 58% to 70%]; specificity 96% [95% CI: 95% to 97%]; negative predictive value 93% [95% CI: 92% to 94%]; accuracy 91% [95% CI: 89% to 92%]). The 3-month outcomes of patients classified as either OCSP "LACS" within 6 hours of onset or TOAST "small vessel (lacunar)" at 7 days were not significantly different.
CONCLUSIONS: An OCSP LACS diagnosis made within 6 hours of stroke onset is reasonably predictive of a final diagnosis of "small vessel (lacunar)" disease made using TOAST criteria and has a similar relationship to outcome at 3 months.
Stephen J Phillips; Dingwei Dai; Arnold Mitnitski; Gordon J Gubitz; Karen C Johnston; Walter J Koroshetz; Karen L Furie; Sandra Black; Darell E Heiselman;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Validation Studies     Date:  2007-08-23
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  38     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-25     Completed Date:  2007-10-18     Revised Date:  2012-10-09    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2706-11     Citation Subset:  IM    
Queen Elizabeth II Health Sciences Centre, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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MeSH Terms
Acute Disease
Aged, 80 and over
Brain Infarction / classification,  diagnosis*,  drug therapy*
Early Diagnosis
Glycine Agents / therapeutic use
Indoles / therapeutic use
Middle Aged
Neuroprotective Agents / therapeutic use*
Predictive Value of Tests
Reproducibility of Results
Sensitivity and Specificity
Severity of Illness Index
Stroke / classification,  diagnosis*,  drug therapy*
Time Factors
Grant Support
Reg. No./Substance:
0/GV 150526A; 0/Glycine Agents; 0/Indoles; 0/Neuroprotective Agents
Comment In:
Stroke. 2008 Oct;39(10):e152; author reply e153   [PMID:  18688005 ]

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