Abstract

BackgroundThe anatomical distribution of acute lacunar infarcts has mainly been studied for supratentorial lesions. In addition, little is known about the association with distinct stroke symptoms, not summarized as classical lacunar syndromes. We aimed to describe the spatial lesion distribution of acute supra- and infratentorial lacunar infarcts and their association with stroke symptoms in patients eligible for thrombolysis.MethodsAll patients enrolled in the WAKE-UP trial (efficacy and safety of magnetic resonance imaging [MRI]-based thrombolysis in wake-up stroke) were screened for lacunar infarcts on diffusion-weighted imaging (DWI). The relationship between the anatomical distribution of supra- and infratentorial lacunar infarcts, their demographic characteristics and acute stroke symptoms, defined by the National Institutes of Health Stroke Scale (NIHSS) score, were correlated and compared.ResultsMaps of lesion distribution from 224 lacunar infarct patients (76 [33.9%] females, mean age [standard deviation] of 63.4 [11.5] years) were generated using computational image mapping methods. Median infarct volume was 0.73 ml (interquartile range [IQR] 0.37–1.15 ml). Median NIHSS sum score on hospital arrival was 4 (IQR 3–6). 165 (73.7%) patients had lacunar infarcts in the supratentorial deep white or grey matter, while 59 (26.3%) patients had infratentorial lacunar infarcts. Patients with supratentorial lacunar infarcts presented with a significantly lower occurrence of deficits in the NIHSS items gaze (p < 0.001) and dysarthria (p = 0.008), but had more often a paresis of the left arm (p = 0.009) and left leg (p = 0.068) compared to patients with infratentorial infarcts.ConclusionsThe anatomical lesion distribution of lacunar infarcts reveals a distinct pattern and supports an association of localization with different stroke symptoms.Trial registrationNCT01525290.

Highlights

  • Lacunar stroke, defined as small subcortical ischemic infarcts, occurs in 20 to 30% of all ischemic strokes [1]

  • Determined by their clinical presentation as lacunar syndromes [4], lacunar infarcts can be verified with high sensitivity by diffusion-weighted imaging (DWI) on acute stroke magnetic resonance imaging (MRI) [5]

  • Applying the recently proposed imaging criteria for lacunar infarcts in the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) position paper [6], the anatomical distribution of lacunar infarcts has been previously studied by MRI with a particular focus on supratentorial locations [7,8,9]

Read more

Summary

Introduction

Lacunar stroke, defined as small subcortical ischemic infarcts, occurs in 20 to 30% of all ischemic strokes [1]. Patients with lacunar infarcts often present with severe clinical deficits and benefit from systemic thrombolysis [3]. Determined by their clinical presentation as lacunar syndromes [4], lacunar infarcts can be verified with high sensitivity by diffusion-weighted imaging (DWI) on acute stroke magnetic resonance imaging (MRI) [5]. Clinical characteristics and anatomical distribution patterns of infratentorial lacunar infarcts have, received less attention, partly due to the lack of data from imaging modalities sensitive to detect small infratentorial stroke. We aimed to describe the spatial lesion distribution of acute supra- and infratentorial lacunar infarcts and their association with stroke symptoms in patients eligible for thrombolysis

Objectives
Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call