Document Detail


Need for extensive diagnostic work-up for patients with lacunar stroke.
MedLine Citation:
PMID:  18283395     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Small-vessel disease is the most frequent cause of lacunar stroke. The aims of this study were to evaluate: 1) alternative causes of lacunar stroke other than small-vessel disease; 2) functional outcome of lacunar strokes due to small vessel disease compared to lacunar strokes due to alternative causes. METHODS: Consecutive patients with first-ever ischemic lacunar stroke were prospectively followed-up for at least 3 months. At discharge patients were divided into 2 groups: lacunar stroke due to small vessel disease (L-SVD) and lacunar stroke due to possible other etiologies (L-non SVD) (e. g. cardioembolism, atherosclerosis or other causes). Main outcome measures were the combined end point of death or disability (mRS >or= 3) and recurrent stroke at the end of follow-up. RESULTS: 535 patients with acute stroke were seen during the study period. Out of these, 196 patients (126 males) with a mean age of 71.6 years (SD = 10) had lacunar stroke. L-SVD was seen in 142 patients (72.4 %) and L-nonSVD in 54 patients (27.6 %). After 16.4 months, 12 patients had died (6.2%; annual mortality rate 4.4 %), 63 were disabled (32.5 %) and 27 had stroke recurrence (13.9%; annual recurrence rate 9.9 %). Forty-nine patients with L-SVD (34.7 %) and 26 with L-nonSVD (49%) had died or become disabled. Sixteen patients with L-SVD (11.3 %) and 11 with L-nonSVD (20.4 %) had stroke recurrence. On multivariate analysis, L-nonSVD (OR = 2.87, 95% CI 1.08-7.65; p = 0.034) and age (OR = 1.07, 95 % CI 1.02-1.12; p = 0.01) were associated to more severe outcome. L-nonSVD was independently associated with recurrence (OR = 5.03, 95% CI 1.54-16.44; p = 0.006). CONCLUSIONS: Twenty-seven percent of patients with lacunar stroke have causes other than small vessel disease. These patients have a severe outcome in terms of recurrence,mortality or disability. These findings support the need for a comprehensive diagnostic work-up for patients with lacunar stroke.
Authors:
Sara Micheli; Giancarlo Agnelli; Francesco Palmerini; Valeria Caso; Michele Venti; Andrea Alberti; Sergio Biagini; Maurizio Paciaroni
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Publication Detail:
Type:  Journal Article     Date:  2008-02-19
Journal Detail:
Title:  Journal of neurology     Volume:  255     ISSN:  0340-5354     ISO Abbreviation:  J. Neurol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-26     Completed Date:  2008-08-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  637-42     Citation Subset:  IM    
Affiliation:
Stroke Unit, Dept. of Cardiovascular Medicine, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06128 Perugia, Italy. saramicheli@hotmail.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Brain / blood supply,  pathology,  physiopathology
Brain Infarction / diagnosis*,  mortality*,  physiopathology
Cerebral Arteries / pathology,  physiopathology
Circle of Willis / pathology,  physiopathology
Disability Evaluation
Disease Progression
Female
Humans
Incidence
Intracranial Arteriosclerosis / diagnosis*,  mortality*,  physiopathology
Intracranial Embolism / diagnosis*,  mortality*,  physiopathology
Italy / epidemiology
Male
Middle Aged
Outcome Assessment (Health Care)
Prospective Studies
Recurrence
Risk Factors
Survival Rate

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