Common Stroke Subtype Research Articles

Trypanosomiasis, cardiomyopathy and the risk of ischemic stroke

American (Chagas disease) and African (sleeping sickness) trypanosomiasis are neglected tropical diseases and are a heavy burden in Latin America and Africa, respectively. Chagas disease is an independent risk factor for stroke. Apical aneurysm, heart failure and cardiac arrhythmias are associated with ischemic stroke in chagasic cardiomyopathy. Not all chagasic patients who suffer an ischemic stroke have a severe cardiomyopathy, and stroke may be the first manifestation of Chagas disease. Cardioembolism affecting the middle cerebral artery is the most common stroke subtype. Risk of recurrence is high and careful evaluation of recurrence risk should be addressed. Repolarization changes, low voltage and prolonged QT interval are common electrocardiography alterations in human African trypanosomiasis, and can be found in more than 70% of patients. Epidemiological studies are needed to asses the risk of stroke in African trypanosomiasis perimyocarditis.

Arterial stiffness is associated with intracranial large artery disease among ethnic Chinese and South Asian ischemic stroke patients

Intracranial large artery disease (ICLAD) is a common stroke subtype that carries a poor prognosis. We studied the association of arterial stiffness, a recognized risk factor for atherosclerosis and ICLAD among ethnic Chinese and South Asian ischemic stroke patients. In this prospective study, we recruited consecutive ischemic stroke patients of Chinese and South Asian ethnicity. ICLAD was assessed by transcranial color-coded Doppler or magnetic resonance angiographic studies. Arterial stiffness was measured by carotid-femoral pulse wave velocity (cPWV). Among the 268 patients studied, the prevalence of ICLAD was 54% and median cPWV was 11.4 m/s (interquartile range 9.0-13.6 m/s). Patients with ICLAD had higher cPWV compared with those without (median 11.7 vs. 11.0 m/s, P = 0.015). In multivariate analysis, patients with ICLAD were significantly more likely to have cPWV measurements in the highest quintile (>14.1 m/s) compared with patients without ICLAD independently of other covariates [odds ratio 2.21, P = 0.038]. This study revealed a novel association between arterial stiffness and ICLAD among ischemic stroke patients. The findings suggest that arterial stiffness may be involved in the pathophysiology of ICLAD. Future studies should investigate the effects of reducing arterial stiffness among stroke patients with ICLAD.

Long-Term Prognosis of Chinese Patients with A Lacunar Infarct Associated with Small Vessel Disease: A Five-Year Longitudinal Study

Lacunar infarct associated with small vessel disease is a common stroke subtype in China and has a favorable short-term prognosis. Data on its long-term prognosis among Chinese patients are lacking. We aimed to study its long-term prognosis and predictors for poor outcomes. We followed up to 75 consecutive Chinese stroke patients who had a lacunar infarct for a period of 5 years. Clinical outcomes with respect to mortality and recurrent stroke were noted. We evaluated baseline clinical and imaging predictors for such outcomes using the Cox regression analysis. Sixteen (21.3%) patients died and 12 (16%) patients had recurrent stroke during follow-up. Twenty-one (28%) patients had combined events of either death and/or recurrent stroke. Univariate Cox regression analysis showed that age, literacy, National Institute of Health Stroke Scale, incident stroke/transient ischemic attack, and white matter lesion volume predicted survival, while, age, National Institute of Health Stroke Scale, systolic blood pressure, hyperhomocysteinemia, silent lacunes, microbleeds, and white matter lesion volume predicted recurrent stroke. Multivariate Cox regression analysis showed that National Institute of Health Stroke Scale (HR 1.25, 95% CI 1.05-1.48) and white matter lesion volume (HR 1.46, 95% CI 1.11-1.92) predicted combined events of mortality and/or recurrent stroke after age adjustment. Approximately one in four patients either died and/or had recurrent stroke within 5 years after a lacunar infarct. Age, stroke severity, and volume of white matter lesion predict a poor long-term prognosis.

A white matter stroke model in the mouse: Axonal damage, progenitor responses and MRI correlates

Subcortical white matter stroke is a common stroke subtype but has had limited pre-clinical modeling. Recapitulating this disease process in mice has been impeded by the relative inaccessibility of the subcortical white matter arterial supply to induce white matter ischemia in isolation. In this report, we detail a subcortical white matter stroke model developed in the mouse and its characterization with a comprehensive set of MRI, immunohistochemical, neuronal tract tracing and electron microscopic studies. Focal injection of the vasoconstrictor endothelin-1 into the subcortical white matter produces an infarct core that develops a maximal MRI signal by day 2, which is comparable in relative size and location to human subcortical stroke. Immunohistochemical studies indicate that oligodendrocyte apoptosis is maximal at day 1 and apoptotic cells extend away from the stroke core into the peri-infarct white matter. The amount of myelin loss exceeds axonal fiber loss in this peri-infarct region. Activation of microglia/macrophages takes place at 1 day after injection near injured axons. Neuronal tract tracing demonstrates that subcortical white matter stroke disconnects a large region of bilateral sensorimotor cortex. There is a robust glial response after stroke by BrdU pulse-labeling, and oligodendrocyte precursor cells are initiated to proliferate and differentiate within the first week of injury. These results demonstrate the utility of the endothelin-1 mediated subcortical stroke in the mouse to study post-stroke repair mechanisms, as the infarct core extends through the partially damaged peri-infarct white matter and induces an early glial progenitor response.

Large Artery Intracranial Occlusive Disease

Large artery intracranial occlusive disease (LAICOD) is a common and important stroke subtype. In this commentary, we review key epidemiological aspects of LAICOD. LAICOD has emerged as the most common stroke subtype worldwide and is associated with a high risk of recurrent stroke. Hypotheses have been proposed to explain causation, which include such factors as traditional cardiovascular risk factors, high blood volume states, and genetic abnormalities. Approaches to treatment such as antithrombotic therapies, revascularization procedures, and counterpulsation devices hold promise. LAICOD poses a major stroke problem worldwide and is likely the most common stroke subtype. The etiology and treatment of this disorder remain poorly defined. International collaborations are needed to pool collective knowledge and develop definitive studies to better understand causation and treatment of LAICOD.

Effect of Ximelagatran and Warfarin on Stroke Subtypes in Atrial Fibrillation

The most common stroke subtype among atrial fibrillation (AF) patients not receiving anticoagulants is cardioembolic. In the SPORTIF III and V trials, the oral direct thrombin inhibitor ximelagatran was as effective as warfarin in reducing the risk of stroke in patients with nonvalvular AF. We assessed any differential effect of warfarin versus ximelagatran on the risk and outcome of cardioembolic and noncardioembolic stroke. 7329 patients with AF and > or = 1 risk factors for stroke were randomized to treatment with warfarin (target international normalized ratio 2.0--3.0) or fixed-dose ximelagatran. Strokes were classified into specific subtypes. Therapeutic effect of warfarin and ximelagatran, adverse events, and stroke outcomes were assessed according to stroke subtype. The annual stroke rate was low for both cardioembolic (ximelagatran, 0.39%; warfarin, 0.47%) and noncardioembolic stroke (ximelagatran, 0.57%; warfarin, 0.37%). In ischemic strokes, 33.9% (ximelagatran) and 34.3% (warfarin) had strokes of presumed cardioembolic origin. When fatal stroke, disabling stroke, myocardial infarction, and death from any cause were combined as poor outcome, patients with cardioembolic strokes had the highest rate of poor outcome (40%) but this was non- significant. In SPORTIF III and V the efficacy of warfarin and ximelagatran were similar for prevention of cardioembolic and noncardioembolic strokes. Overall outcome tended to be worse following cardioembolic stroke. Ximelagatran has been withdrawn from the market due to hepatic side effects, but similar compounds are presently being studied.

Stroke in Qatar: A First Prospective Hospital-based Study of Acute Stroke

Stroke is a major cause of morbidity and mortality in Qatar. The aim of our study was to determine types of strokes, the associated risk factors, clinical presentation, outcome, and time to hospital admission among Qatari and non-Qatari patients as well as young and nonyoung patients. We conducted a hospital-based prospective observational study including all patients admitted to Hamad Medical Corporation with first-ever stroke from September 15, 2004, to September 14, 2005. A stroke was defined according to World Health Organization criteria. Stroke was confirmed in 270 patients of whom 217 (80.4%) had ischemic stroke and 53 (19.6%) had hemorrhagic stroke. Male patients predominated in all types of stroke. The main risk factors for stroke were hypertension and diabetes, whereas lacunar infarct was the most common subtype of ischemic stroke. Risk factor profiles were similar between Qatari and non-Qatari patients except for hypercholesterolemia, which was observed with a higher frequency in Qatari compared with non-Qatari patients with ischemic stroke. There were significant differences between the young and nonyoung patients with ischemic stroke with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome. Most patients arrived at the hospital more than 3 hours from stroke onset because of unawareness of stroke symptoms. The overall in-hospital mortality was 9.3%. Hypertension and diabetes mellitus were the main risk factors for stroke in Qatar, whereas lacunar infarct was the most common subtype. Significant differences between the young and nonyoung patients were observed with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome.

Prevalence of extracranial carotid stenosis in Thai ischemic stroke/TIA patients

Stroke is a leading cause of death and morbidity in Thailand. The purpose of this study was to look for prevalence of significant extracranial carotid stenosis (ECCS) in Thai ischemic stroke/transient ischemic attack (TIA) patients and baseline characteristics of this subgroup. All acute/subacute ischemic stroke/TIA patients who were treated at Thammasat hospital and had carotid duplex done, during August 2006-July 2007, were included. Carotid duplex studies were performed in all clinically stable patients. The degree of stenosis was defined according to the standard velocity criteria. Stroke subtypes were classified by TOAST criteria: large-artery atherosclerosis (LAA), cardioembolism (CE), small-artery occlusion (SAO), stroke of other determined cause (OC) and stroke of undetermined cause (UND). One-hundred and eighty-four cases were included. Prevalence of significant ECCS was 9.2%. SAO subtype was the most common stroke subtype in our study (45%). Significant ECCS was found in 18.4%, 6% and 8.3% patients with LAA, SAO and CE stroke subtype, respectively. Significant ECCS in Thai ischemic stroke/TIA patients is uncommon. Low prevalence of coronary artery disease and peripheral artery disease in Thai stroke patients and/or high SAO stroke subtype in our patients may explain this.

Stroke presentation in Type 2 diabetes and the metabolic syndrome

Introduction The metabolic syndrome (MetS) is associated with macrovascular disease and an altered pattern of cerebrovascular disease. We investigated stroke subtype presentation in Type 2 diabetic (T2D) patients, and analysed patients with and without the MetS. Methods We performed a retrospective analysis of 243 T2D patients with first presentation of stroke from our Diabetes Centre database. The MetS was diagnosed in patients with T2D and two or more additional risk factors (obesity, low HDL cholesterol, elevated triglycerides or hypertension). We analysed the clinical stroke subtype presentation, using the Oxford classification of stroke, into cortical and lacunar (small vessel disease) stroke. Results The MetS was diagnosed in 151 T2D patients (62%), with 86 male and 65 female patients (age: 71.8 ± 9.7). Comparing the MetS and non-MetS groups, the distribution of stroke subtypes adjusted for age and sex were: cortical stroke (13.2% versus 15.2%; P = 0.56), lacunar stroke (43.7% versus 43.5%; P = 0.87) and TIA (38.4% versus 39.1%; P = 0.98). Lacunar stroke incidence was significantly higher compared to cortical stroke in both groups ( P < 0.001). Conclusion In this study of T2D patients, lacunar stroke (small vessel disease) was the most common stroke subtype in both patients with and without the MetS.

Cardiovascular diseases in ChinaThis paper is one of a selection of papers in this Special Issue, entitled International Symposium on Recent Advances in Molecular, Clinical, and Social Medicine, and has undergone the Journal's usual peer-review process.

Statistics from the National Population Census of China revealed a significant increase in the Chinese population, from 590 million in 1953 to 1.26 billion in 2000. The average life expectancy increased to 71.4 years in 2000 compared with the expectancy of 68.6 years a decade before. World Health Organization statistics on the death rate for total cardiovascular disease, coronary heart disease, and stroke in men and women aged 35-74 years revealed discrepancies between rural and urban parts of China. The China Multicenter Collaborative Study of Cardiovascular Epidemiology indicated that cardiovascular disease was the major cause of death for both men and women, with stroke accounting for over 40% of deaths. Ischemia was shown to be the most common subtype of stroke in both sexes. Smoking was an independent risk factor for cardiovascular disease. The World Health Organization reported that the death rate attributable to tobacco was 6.0% worldwide and 9.2% in China in 1990. The latter is projected to reach 16.6% by 2020. In China, the prevalence of hypertension and diabetes mellitus, the two key risk factors of cardiovascular disease, have also increased significantly in the past 20 years. In addition, elevated blood pressure and plasma cholesterol were two important determinants of increased cardiovascular disease in eastern Asia. These studies indicate that an integrated management of comprehensive risk is urgently required to address China's increasing cardiovascular disease burden.

Interobserver Agreement in the Trial of Org 10172 in Acute Stroke Treatment Classification of Stroke Based on Retrospective Medical Record Review

The reliability of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system of stroke in siblings of stroke-affected probands has not been tested. Similarly, the reliability of using clinical medical records to classify ischemic stroke has not been assessed. The purpose of this study was to establish the interrater reliability of sibling stroke subtyping by applying the TOAST criteria to retrospectively obtained medical records. Thirty medical records were randomly sampled from among the records of all siblings previously classified as stroke affected by the Siblings with Ischemic Stroke Study (SWISS) Stroke Verification Committee. Blinded medical records for these individuals were sent to 6 physician reviewers who independently classified TOAST stroke subtype on the basis of record review. Using the kappa statistic to assess interrater reliability, the overall reliability (SE) for assigning a TOAST subtype of stroke was 0.54 (0.03). Pair-wise comparisons between the original SWISS Stroke Verification Committee diagnoses and the diagnoses made by other reviewers exhibited moderate reliability (kappa range 0.41-0.56). The kappa statistics for common stroke subtypes were large vessel, 0.80 (0.06); cardioembolic, 0.80 (0.06); small vessel, 0.53 (0.06); and unknown cause, 0.40 (0.06). We conclude that TOAST subtyping had moderate interrater reliability. Large-artery and cardioembolic subtype diagnoses seemed most reliable.

Ethnic Variations in Risk Factor Profile, Pattern and Recurrence of Non-Cardioembolic Ischemic Stroke

Ischemic stroke is influenced by ethnic and geographical variations. The aim of this study was to identify the risk factor profiles, subtypes and recurrence of non-cardioembolic ischemic stroke for the two largest subpopulations, the Arab and South Asians, at the only stroke-admitting hospital in Qatar. Data on stroke patients admitted to Hamad Medical Corporation from January through December 2001 were reviewed in January 2005. Only patients with non-cardioembolic ischemic stroke and complete work-up were included. A total of 303 patients with ischemic non-cardioembolic stroke fit the entry criteria. Sixty seven percent of the overall patient population (sex ratio 2:6, M/F) was of Arab origin, and 32% were South Asians. Hypertension was the most commonly encountered risk factor followed by dyslipidemia, diabetes mellitus, and obesity. Significant differences between the Arab and South Asian subgroup of patients were observed with respect to number of risk factors and occurrence of obesity and diabetes. Carotid artery stenotic lesions, ventricular wall motion abnormalities and stroke recurrence were observed with a higher frequency in the Arab subgroup of patients compared with the South Asians. The majority of strokes were lacunar hemispheric strokes (68%), followed by lacunar brainstem strokes (15%) and large-vessel hemispheric infarctions (10%). Patients with a previous history of stroke had a higher frequency of carotid artery stenosis (p = 0.05) and risk of stroke recurrence (p = 0.04). Unlike in other studies originating from the Arabian Gulf, lacunar stroke is the most common subtype of non-cardioembolic ischemic stroke in both the Arabs and South Asians in Qatar. Significant ethnic differences in age of occurrence, risk factor profile, and cardiovascular variables were observed.

Proportions of Stroke Subtypes Among Men and Women ≥40 Years of Age in an Urban Japanese City in 1992, 1997, and 2002

Higher proportions of hemorrhagic stroke and lacunar infarction were reported in rural Japan compared with those in Western countries. We examined the relative proportions of stroke subtypes in an urban Japanese city where westernized lifestyles are more common than in rural areas. Stroke registration was performed in 1992, 1997, and 2002 for residents > or =40 years of age who were admitted with acute strokes to all of the 10 hospitals with > or =90 beds in Yao City, Osaka, Japan. Strokes were classified as intraparenchymal hemorrhage, subarachnoid hemorrhage, or ischemic strokes (embolic infarction, large-artery occlusive infarction, lacunar infarction, and unclassified thrombotic infarction) by criteria using computed tomography or MRI. A total of 650 first-ever strokes were registered. The age-adjusted proportion of each stroke subtype was not significantly different among the 3 study periods in both men and women. Throughout the 3 periods, intraparenchymal hemorrhage, subarachnoid hemorrhage, and ischemic stroke accounted for 26%, 7%, and 65% in men, respectively. In women, the respective proportions were 29%, 21%, and 44%. The proportion of each subtype for total ischemic strokes was as follows: 51% to 61% lacunar infarction, 25% to 26% large-artery occlusive infarction, and 11% to 17% embolic infarction. Our study showed that hemorrhagic stroke represented a large proportion of all strokes, especially among women, and lacunar infarction was the most common subtype of ischemic stroke among both men and women in Yao City, which differed from findings in Western countries.

Subtyping of Ischemic Stroke Based on Vascular Imaging: Analysis of 1,167 Acute, Consecutive Patients

Background and PurposeKnowledge of a patient's cerebral vascular status is essential for accurately classifying stroke. However, vascular evaluations have been incomplete in previous studies, and a stroke registry based on the results of such vascular investigations has not been reported. The purpose of the present study was to classify ischemic strokes based on vascular imaging data.MethodsBetween May 2001 and August 2003, 1,264 patients with acute (< 7 days) ischemic stroke were admitted to Asan Medical Center. Among them, 1,167 patients (750 men and 417 women; mean age 63.3 years) underwent an angiogram (mostly a magnetic resonance angiogram) and were included in this study. Electrocardiography and computed tomography/magnetic resonance imaging were performed in all patients, while 31.2% underwent echocardiography. The subtypes were categorized with the aid of a modification of the Trial of ORG 10172 in the Acute Stroke Treatment classification.ResultsLarge-artery atherosclerosis (LAA) was the most frequent subtype (42%), followed by small-vessel occlusion (SVO, 27%), cardiogenic embolism (CE, 15%), undetermined etiology (15%), and other determined etiology (1.5%). Risk factors included hypertension (71%), cigarette smoking (35%), diabetes mellitus (30%), history of previous stroke (22.7%), emboligenic cardiac diseases (20%), and hypercholesterolemia (11%). Hypertension was more common in patients with SVO than in those with other subtypes (p<0.05), and the case-fatality rate was higher in patients with CE than in those with other subtypes (p<0.01). The functional outcome was worse in patients with LAA than in those with other stroke subtypes (p<0.01).ConclusionAccording to the stroke registry based on vascular imaging results, LAA was the most common stroke subtype followed by SVD. The high incidence of LAA is probably related to the increased identification of the presence of intracranial atherosclerosis by MR angiogram.

Ischaemic stroke in Jordan: a 2-year hospital-based study of subtypes and risk factors

A retrospective study was made of 200 consecutive patients with first-ever ischaemic stroke, admitted to Jordan University Hospital over a 2-year period. The mean age was 61.2 years (range 29-95). The most common stroke subtype was lacunar infarct (51.5%), but frequency of cardioembolic stroke was low (8.0%). Hypertension, diabetes mellitus and smoking were the most common risk factors for atherosclerotic non-cardioembolic stroke. Chronic atrial fibrillation was the most common risk factor for cardioembolic stroke. No patient had severe extracranial carotid or vertebral artery stenosis (> 50% narrowing). Lacunar strokes presented predominantly as pure motor stroke (67/103) and were mainly in the internal capsule (34/ 103). The favourable outcome (85% discharged home) may be due to the relatively young age and the predominance of lacunar infarcts.

Ischemic stroke in Jordan 2000 to 2002: A two-year, hospital-based study

A total of 200 consecutive patients with first ischemic stroke seen at Jordan University Hospital in Amman, Jordan, during a 2-year period were studied retrospectively. Mean age was 61.2 years (range: 29–95 years). The most common stroke subtype was lacunar infarct (51%), but the frequency of cardioembolic strokes was low (8%). Hypertension, diabetes mellitus, coronary artery disease, and smoking were the most common risk factors for atherosclerotic noncardioembolic strokes. Chronic atrial fibrillation was the most common risk factor for cardioembolic strokes. No patient had significant (>50%) extracranial carotid or vertebral artery stenosis. The outcome was relatively good; 85% of patients were discharged home, the majority with only mild neurologic deficit. The favorable outcome is most likely because of the relatively young mean age and the predominance of lacunar infarcts.

Progression of Dementia Associated with Lacunar Infarctions

Background: Lacunar stroke (L) is the most common stroke subtype associated with vascular dementia (VaD-L). Objective: To evaluate the cognitive and behavioral course in patients with probable VaD-L. Methods: We longitudinally measured rates of change on MMSE, digit span, logical memory, Controlled Oral Word Association, CERAD battery and neuropsychiatric inventory (NPI) in 77 patients (age at entry 69 ± 8.1 years) with probable VaD-L for 25.75 ± 11 months. Results: The mean number of follow-up visits was 2.6 ± 0.67 (range 2–4). Time interval between any two consecutive visits was at least 5 months (range 5–41). MMSE deteriorated by 1.44± 1.8 points annually and NPI increased by 6.01 ± 13.7 points annually (p < 0.0001). The rates of cognitive and behavioral decline were predominantly influenced by the cognitive state at entry into the study and the occurrence of new vascular episodes during follow-up [(–0.95 ± 1.7) MMSE and (+2.02 ± 14.1) NPI points annually without vascular episodes vs. (–2.09 ± 1.6) and (+11.3 ± 11.4) points following vascular episodes (p < 0.0001)]. Impaired cognition was associated with impaired behavior (p < 0.001). VaD-L patients without additional vascular episodes at follow-up have a progressively deteriorating course as well (p < 0.0001). Conclusion: VaD-L is characterized by cognitive and behavioral decline. The rate of decline is determined mainly by the severity of the cognitive and behavioral impairment at baseline and by the occurrence of new vascular episodes.

Natural history of dementia associated with lacunar infarctions

Background: Lacunar stroke (VaD-L) is the most common stroke subtype associated with vascular dementia (VaD). Objective: To evaluate the rate of cognitive and behavioral changes in patients with probable VaD-L. Methods: We measured rates of change on the Mini-Mental State Examination (MMSE), Digit Span, Logical Memory, Controlled Oral Word Association Test, CERAD battery and the Neuropsychiatric Inventory (NPI) of 77 [age at entry 65.9±8.1 (mean±standard deviation) years] patients with probable VaD, periventricular white matter and basal ganglia lacunae, longitudinally studied for 25.7±11 months. Results: Mean number of follow-up visits was 2.6. Overall annual vascular event rate was 0.25. VaD-L in mildly and moderately impaired patients is characterized by progressive cognitive and behavioral decline. The rate of cognitive and behavioral progression depends on the occurrence of vascular episodes (VE) during the course of the illness [(−1.1) MMSE and (+4.0) NPI points annually without VE vs. (−2.0) and (+10.3) points following VE]. The rates of progression are a function of the severity of the cognitive and behavioral impairment. Impaired cognition is associated with impaired behavior. A subgroup of VaD-L patients runs a progressively deteriorating course despite the absence of clinically apparent new vascular episodes. Conclusion: VaD-L is characterized by cognitive and behavioral decline in 83% of the patients. The rate of decline is determined mainly by the severity of the cognitive and behavioral impairment at baseline and by the occurrence of new vascular episodes.

Carotid artery intima-media thickness and lacunar versus nonlacunar infarcts.

Increases in the thickness of the intima and media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtype of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examines the relationship between vascular risk factors, including carotid artery intima-media thickness (IMT), and lacunar versus nonlacunar infarcts. We collected data from patients with acute ischemic stroke admitted to hospital. Patients and 129 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and nonlacunar infarcts with age, sex, and potential vascular risk factors. Of 292 adult patients with an acute first-ever ischemic stroke, 96 were considered lacunar and 196 were considered nonlacunar strokes. We did not find a significantly different percentage of diabetes, smoking, hypertension, dyslipidemia, myocardial infarction, and previous transient ischemic attack between the 2 groups of patients. The multinomial logistic regression procedure selected carotid artery IMT and atrial fibrillation as the only independent factors able to discriminate between lacunar and nonlacunar patients. IMT values were significantly higher in patients with nonlacunar stroke versus both those with lacunar stroke and control subjects. The present results indicate the usefulness of noninvasive measurement of IMT with ultrasonic techniques as a diagnostic tool that may help to identify different subtypes of ischemic stroke patients. The noninvasive measurements may have predictive power with respect to lacunar versus nonlacunar infarcts.

A Community-Based Outcome Study of Common Ischemic Stroke Subtypes

In this community-based study of functional outcome, survival, and recurrence for ischemic stroke subtypes, these authors identified all residents of