Journal of Neurology

, Volume 255, Issue 5, pp 637–642

Need for extensive diagnostic work-up for patients with lacunar stroke

  • S. Micheli
  • G. Agnelli
  • F. Palmerini
  • V. Caso
  • M. Venti
  • A. Alberti
  • S. Biagini
  • M. Paciaroni
ORIGINAL COMMUNICATION

DOI: 10.1007/s00415-008-0762-5

Cite this article as:
Micheli, S., Agnelli, G., Palmerini, F. et al. J Neurol (2008) 255: 637. doi:10.1007/s00415-008-0762-5
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Abstract

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 ≥ 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.

Key words

lacunar stroke stroke recurrence stroke outcome 

Copyright information

© Steinkopff-Verlag 2008

Authors and Affiliations

  • S. Micheli
    • 1
  • G. Agnelli
    • 1
  • F. Palmerini
    • 1
  • V. Caso
    • 1
  • M. Venti
    • 1
  • A. Alberti
    • 1
  • S. Biagini
    • 1
  • M. Paciaroni
    • 1
  1. 1.Stroke Unit, Dept. of Cardiovascular Medicine, University of PerugiaOspedale Santa Maria della Misericordia, Sant'Andrea delle FrattePerugiaItaly

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