Cerebral microbleeds and white matter changes in patients hospitalized with lacunar infarcts (original) (raw)
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Prospective Study of Single and Multiple Lacunar Infarcts Using Magnetic Resonance Imaging
Stroke, 2003
Background and Purpose— We investigated whether lacunar infarct (LI) patients with >1 lacune have different vascular risk factors, a different prognosis, and poorer functional outcome than those with a single lacune. Methods— The study included 175 first-ever LI patients. The group was divided according to the presence of multiple (n=136) or single (n=39) LI. The association of single or multiple LI with the principal vascular risk factors, leukoaraiosis, outcome, and recurrence was investigated with logistic regression models that included age, sex, and cardiac disease. Results— No significant differences were found between single and multiple LI with respect to age, hypertension, hyperlipidemia, smoking, and heavy alcohol drinking. Diabetes mellitus (odds ratio [OR], 2.43; 95% CI, 1.09 to 5.4), high levels of hematocrit (>0.47) (OR, 1.09; 95% CI, 1.04 to 1.21), and leukoaraiosis (OR, 3.58; 95% CI, 1.77 to 7.51) were significantly related to multiple but not to single LI. Str...
Stroke, 2003
Results No significant differences were found between single and multiple LI with respect to age, hypertension, hyperlipidemia, smoking, and heavy alcohol drinking. Diabetes mellitus (odds ratio [OR], 2.43; 95% CI, 1.09 to 5.4), high levels of hematocrit (>0.47) (OR, 1.09; 95% CI, ...
International Journal of Stroke, 2009
Rationale 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.Aims We aimed to study its long-term prognosis and predictors for poor outcomes.Design 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.Study Outcomes 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.Conclusion 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 case study: Multiple Lacunar Infarct using Magnetic Resonance Imaging
2021
Background: An ischemic stroke takes place when a blood vessel supplying the brain is blocked and blood circulation to a part of the brain is damaged. A lacunar stroke occurs due to one of the arteries that provide blood to the brain's deep structures is blocked. Case Study: A 55-year-old male patient have right cerebrovascular accident (CVA) with left hemiparesis on 16th of August 2019. Normal result was seen by brain Computed Tomography (CT) scanning. Magnetic Resonance Imaging (MRI) brain was done resulted in hyperintense lesion in right pons and foci and Magnetic Resonance Angiography (MRA) was done and resulted in severe basilar artery stenosis.
The contribution of acute infarcts to cerebral small vessel disease progression
Annals of Neurology
Objective: To determine the contribution of acute infarcts, evidenced by diffusion-weighted imaging positive (DWI+) lesions, to progression of white matter hyperintensities (WMH) and other cerebral small vessel disease (SVD) markers. Methods: We performed monthly 3T magnetic resonance imaging (MRI) for 10 consecutive months in 54 elderly individuals with SVD. MRI included high-resolution multishell DWI, and 3-dimensional fluid-attenuated inversion recovery, T1, and susceptibility-weighted imaging. We determined DWI+ lesion evolution, WMH progression rate (ml/mo), and number of incident lacunes and microbleeds, and calculated for each marker the proportion of progression explained by DWI+ lesions. Results: We identified 39 DWI+ lesions on 21 of 472 DWI scans in 9 of 54 subjects. Of the 36 DWI+ lesions with follow-up MRI, 2 evolved into WMH, 4 evolved into a lacune (3 with cavity <3mm), 3 evolved into a microbleed, and 27 were not detectable on follow-up. WMH volume increased at a median rate of 0.027 ml/mo (interquartile range = 0.005-0.073), but was not significantly higher in subjects with DWI+ lesions compared to those without (p = 0.195). Of the 2 DWI+ lesions evolving into WMH on follow-up, one explained 23% of the total WMH volume increase in one subject, whereas the WMH regressed in the other subject. DWI+ lesions preceded 4 of 5 incident lacunes and 3 of 10 incident microbleeds. Interpretation: DWI+ lesions explain only a small proportion of the total WMH progression. Hence, WMH progression seems to be mostly driven by factors other than acute infarcts. DWI+ lesions explain the majority of incident lacunes and small cavities, and almost one-third of incident microbleeds, confirming that WMH, lacunes, and microbleeds, although heterogeneous on MRI, can have a common initial appearance on MRI.
Diffusion-Weighted Imaging Identifies a Subset of Lacunar Infarction Associated With Embolic Source
Stroke, 1999
Background and Purpose-Small infarcts in the territory of penetrator arteries were described as causing a number of distinct clinical syndromes. The vascular pathophysiology underlying such infarcts is difficult to ascertain without careful pathological study. However, the occurrence of multiple, small infarcts, linked closely in time but dispersed widely in the brain, raises the possibility of an embolic mechanism. The current study determines the frequency and clinical characteristics of patients with well-defined lacunar syndromes and the diffusion-weighted imaging (DWI) evidence of multiple acute lesions. Methods-Sixty-two consecutive patients who presented to the emergency room with a clinically well-defined lacunar syndrome were studied by DWI within the first 3 days of admission. Results-DWI showed multiple regions of increased signal intensity in 10 patients (16%). A hemispheric or brain stem lesion in a penetrator territory that accounted for the clinical syndrome ("index lesion") was found in all. DWI-hyperintense lesions other than the index lesion ("subsidiary infarctions") were punctate and lay within leptomeningeal artery territories in the majority. As opposed to patients with a single lacunar infarction, patients with a subsidiary infarction more frequently (PϽ0.05) harbored an identifiable cause of stroke.
Silent lacunar infarction on magnetic resonance imaging (MRI): Risk factors
Journal of the Neurological Sciences, 1998
Abstract´Ẃ e investigated the risk factors for silent lacunar infarction and etat crible detected by magnetic resonance imaging (MRI). Previous reports have evaluated white matter hyperintensities (WMHs) and periventricular hyperintensities (PVHs) on T2-weighted images, buth ave not distinguished between lacunar infarcts, etat crible, and leukoaraiosis of Binswanger's type. MRI scans were performed in 270 subjects without neurological deficits over the age of 40 years. They were classified into four subtype groups based on MR findings:ń ormal group (n560), etat crible group (n569), silent lacunar infarct / PVH(2) group (n561), and silent lacunar infarct / PVH(1) group (n580). We examined the following biochemical variables and other potential risk factors by ordinary logistic regression analysis to identify independent and significant risk factors for silent lacunar infarction: serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, lipoprotein(a), HbA , age, sex, systolic blood pressure, diastolic blood pressure, duration of 1c hypertension, family history, smoking habits, alcohol intake, obesity (body mass index), and atrial fibrillation. Subjects in the silent lacunar infarct / PVH(2) (P,0.01) and PVH(1) (P,0.001) groups were significantly older than normal subjects. The systolic blood pressure was also significantly higher in the silent lacunar infarct / PVH(2) (P,0.04) and PVH(1) (P,0.01) groups compared with the normal group. The duration of hypertension was significantly longer in the silent lacunar infarct / PVH(1) group (P,0.02). There were no significant differences in other risk factors between the normal group and the other groups. Ordinary logistic regression analysis showed that age (chi-square 51.8, P,0.0001) and systolic blood pressure (chi-square 5.7, P,0.02) were significant and independent risk factors for silent lacunar infarction. Aging and hypertension were shown to be independent risk factors for silent lacunar infarction.
Diagnosing acute lacunar infarction using CT perfusion
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2016
The value of CT perfusion (CTP) in detecting acute lacunar infarcts (LACI) has not been well established. We tested the sensitivity of CTP for LACI. CTP maps of consecutive stroke patients from 2009-2013 were examined. MRI diffusion imaging was used to identify those with LACI. Two stroke neurologists independently evaluated the CTP maps for evidence of a perfusion lesion in a deep perforating artery territory. Cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) and time to maximum (Tmax) maps were first examined in isolation and then in combination. Inter-observer agreement was measured using Cohen's κ. The lesions identified were later confirmed against the diffusion MRI reference and the sensitivity and specificity of CTP maps calculated. A total of 63 patient scans were analysed. There were 32 patients with MRI-confirmed LACI within the coverage of CTP; 18 in the striatum, 10 thalamic, and four in the corona radiata. Another 31 patients had normal...
Cerebrovascular Diseases, 2007
Background: Lacunar stroke has been defined as an infarct <15 mm in diameter in the presence of symptoms of lacunar syndromes. We investigated a new approach in predicting whether a deep infarct is caused by small arterial occlusion. Methods: A total of 319 consecutive patients with acute symptomatic infarcts within the striatocapsular territory underwent diffusion-weighted imaging (DWI) and diagnostic workups, including vascular and cardiological studies. Predictors for nonlacunar mechanisms were evaluated by logistic regression analysis, with the size of infarct (1-mm increase) and stroke syndrome (traditional vs. atypical lacunar syndrome vs. cortical syndrome) graded rather than dichotomized. Results: Amongst the 171 patients who did not meet the established criteria for lacunar stroke, that is, deep infarct of ≧15 mm or presenting symptoms of nontraditional lacunar syndrome, a documented etiology could not be determined in 97 (56.7%) patients. In contrast, amongst the 148 pa...