Progressive stroke caused by CT-verified small deep infarcts; relation with the size of the infarct and clinical outcome.

In 73 of 83 consecutive patients with a CT-verified small deep infarct, the course of the initial deficit was retrospectively assessed. Sixty-four percent showed their maximal deficit at stroke onset, while 36% had progression of the initial deficit. Between these 2 groups, there was no difference in the number of patients with hypertension and in the number of patients with a probable cardiac embolic cause of the lacunar stroke. Patients with progressive lacunar stroke had larger volume infarcts and showed less favourable outcome at one month. Our data suggest that progression of symptoms in patients suffering a small deep infarct is due to an increase of the infarcted area. This offers a rationale for early anticoagulant treatment in patients with small deep infarcts. However, since any beneficial effect of such treatment has not been established so far, a prospective controlled study is warranted.