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

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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.

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Authors and Affiliations

  1. Stroke Unit, Dept. of Cardiovascular Medicine, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06128, Perugia, Italy

    S. Micheli MD, G. Agnelli MD, F. Palmerini MD, V. Caso MD, PhD, M. Venti MD, PhD, A. Alberti MD, S. Biagini MD & M. Paciaroni MD

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  1. S. Micheli MD
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  2. G. Agnelli MD
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  3. F. Palmerini MD
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  4. V. Caso MD, PhD
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  5. M. Venti MD, PhD
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  6. A. Alberti MD
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  7. S. Biagini MD
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  8. M. Paciaroni MD
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Correspondence to S. Micheli MD.

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Micheli, S., Agnelli, G., Palmerini, F. et al. Need for extensive diagnostic work-up for patients with lacunar stroke. J Neurol 255, 637–642 (2008). https://doi.org/10.1007/s00415-008-0762-5

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  • DOI: https://doi.org/10.1007/s00415-008-0762-5

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