BACKGROUND AND PURPOSE: On brain imaging, lacunes, or cerebrospinal fluid-containing cavities, are common and are often counted in epidemiological studies as old lacunar infarcts. The proportion of symptomatic lacunar infarcts that progress to lacunes is unknown. Noncavitating lacunar infarcts may continue to resemble white matter lesions. METHODS: We identified patients with acute lacunar stroke, with or without an acute lacunar infarct on computed tomography or MRI, who had follow-up imaging. A neuroradiologist classified lacunar infarcts progressing to definite or possible cavities on follow-up imaging. We tested associations between cavitation and patient-related, stroke-related, and imaging-related features, including other features of small vessel disease. RESULTS: Among 90 patients (mean age 67 years), any cavitation was present on follow-up imaging in 25 (28%), and definite cavitation in 18 (20%). Definite cavitation was associated with increasing time to follow-up imaging (median 228 days, range 54 to 1722, versus no cavitation 72 days, range 6 to 1440; P=0.0003) and deep cerebral atrophy (P=0.03) but not with age, stroke severity, larger initial infarct size, or other features of small vessel disease. Hypertension and diabetes were negatively associated with cavitation (P=0.01 and 0.02, respectively). CONCLUSIONS: Definite cavitation occurs in one fifth of symptomatic lacunar ischemic strokes, implying that most continue to resemble white matter lesions. Epidemiology and pathophysiology studies of lacunar stroke, which have only counted lacunes as lacunar infarcts, may have substantially underestimated by as much as 5 times the true burden of lacunar stroke disease.
BACKGROUND AND PURPOSE: On brain imaging, lacunes, or cerebrospinal fluid-containing cavities, are common and are often counted in epidemiological studies as old lacunar infarcts. The proportion of symptomatic lacunar infarcts that progress to lacunes is unknown. Noncavitating lacunar infarcts may continue to resemble white matter lesions. METHODS: We identified patients with acute lacunar stroke, with or without an acute lacunar infarct on computed tomography or MRI, who had follow-up imaging. A neuroradiologist classified lacunar infarcts progressing to definite or possible cavities on follow-up imaging. We tested associations between cavitation and patient-related, stroke-related, and imaging-related features, including other features of small vessel disease. RESULTS: Among 90 patients (mean age 67 years), any cavitation was present on follow-up imaging in 25 (28%), and definite cavitation in 18 (20%). Definite cavitation was associated with increasing time to follow-up imaging (median 228 days, range 54 to 1722, versus no cavitation 72 days, range 6 to 1440; P=0.0003) and deep cerebral atrophy (P=0.03) but not with age, stroke severity, larger initial infarct size, or other features of small vessel disease. Hypertension and diabetes were negatively associated with cavitation (P=0.01 and 0.02, respectively). CONCLUSIONS: Definite cavitation occurs in one fifth of symptomatic lacunar ischemic strokes, implying that most continue to resemble white matter lesions. Epidemiology and pathophysiology studies of lacunar stroke, which have only counted lacunes as lacunar infarcts, may have substantially underestimated by as much as 5 times the true burden of lacunar stroke disease.
Authors: Marco Duering; Ruth Adam; Frank A Wollenweber; Anna Bayer-Karpinska; Ebru Baykara; Leidy Y Cubillos-Pinilla; Benno Gesierich; Miguel Á Araque Caballero; Sophia Stoecklein; Michael Ewers; Ofer Pasternak; Martin Dichgans Journal: J Cereb Blood Flow Metab Date: 2019-07-25 Impact factor: 6.200
Authors: Francesco Arba; Benedetta Piccardi; Vanessa Palumbo; Betti Giusti; Patrizia Nencini; Anna Maria Gori; Alice Sereni; Mascia Nesi; Giovanni Pracucci; Giorgio Bono; Paolo Bovi; Enrico Fainardi; Domenico Consoli; Antonia Nucera; Francesca Massaro; Giovanni Orlandi; Francesco Perini; Rossana Tassi; Maria Sessa; Danilo Toni; Rosanna Abbate; Domenico Inzitari Journal: Transl Stroke Res Date: 2018-04-23 Impact factor: 6.829
Authors: Marco Duering; Ruthger Righart; Frank Arne Wollenweber; Vera Zietemann; Benno Gesierich; Martin Dichgans Journal: Neurology Date: 2015-03-25 Impact factor: 9.910
Authors: N S Rost; R M Rahman; A Biffi; E E Smith; A Kanakis; K Fitzpatrick; F Lima; B B Worrall; J F Meschia; R D Brown; T G Brott; A G Sorensen; S M Greenberg; K L Furie; J Rosand Journal: Neurology Date: 2010-11-09 Impact factor: 9.910
Authors: Jacques De Reuck; Florent Auger; Nicolas Durieux; Charlotte Cordonnier; Vincent Deramecourt; Florence Pasquier; Claude-Alain Maurage; Didier Leys; Regis Bordet Journal: Eur Stroke J Date: 2016-05-18