Are Lacunar Strokes Really Different?

Abstract

Background and Purpose-Differences in risk factors between lacunar and nonlacunar infarcts might support a distinct arterial pathological process underlying lacunar infarction. Methods-We did a systematic review of studies comparing risk factors in patients with lacunar versus nonlacunar infarction. For each risk factor, we calculated study-specific and pooled relative risks (RRs) for lacunar versus nonlacunar infarction. Results-A total of 16 of 28 studies included risk factors in their ischemic stroke subtype definitions. Hypertension and diabetes appeared commoner among patients with lacunar versus nonlacunar infarction. However, analyses confined to studies using risk factor-free ischemic subtype definitions found only a marginal excess of hypertension with lacunar versus nonlacunar infarction (RR, 1.11; 95% CI, 1.04 to 1.19) and no difference for diabetes (RR, 0.95; 95% CI, 0.83 to 1.09). Atrial fibrillation and carotid stenosis were associated more with nonlacunar than lacunar infarction but less so when only studies using risk factor-free classifications were considered. Otherwise, there was no evidence of differences in risk factor profiles. Conclusions-Risk factor-free ischemic stroke subtype classification methods should be used for comparing risk factor profiles between lacunar and nonlacunar subtypes.

Linoleic Acid in Adipose Tissue and Development of Ischemic Stroke: A Danish Case‐Cohort Study

“…Numerous studies have thus reported a beneficial effect of LA on blood lipids and blood pressure 23, 24. Since hypercholesterolemia and hypertension have a different impact on the large precerebral arteries and the small cerebral arteries,9, 25, 26 this could partly explain the observed differences in risk between subtypes of ischemic stroke. We found a lower risk of large artery atherosclerosis and indications of a negative association between LA content in adipose tissue and small‐vessel occlusion.…”

“…Furthermore, only few studies with biomarkers of LA exposure and the risk of ischemic stroke have been undertaken and results have been inconsistent. Moreover, LA has been suggested to play different roles in different cerebral arteries9, 10, 11 and the influence of LA could thus be different among subtypes of ischemic stroke. In this study, we examined the association between the content of LA in adipose tissue and incident ischemic stroke, as well as subtypes classified according to The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification,12 a system for categorization mainly based on pathogenesis.…”

The relationship between aortic stiffness and changes in retinal microvessels among Asian ischemic stroke patients

“…Stroke was subtyped using a pragmatic modification of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification used in the Greater Metropolitan Clinical Taskforce for Stroke in New South Wales, Australia. 23,28 All patients had brain imaging with either computed tomography or magnetic resonance imaging. Those with anterior circulation infarction had carotid ultrasound.…”

A case of paradoxical brain embolism presenting as a typical lacunar stroke

“…About 10% of lacunar syndromes are due to non ischemic brain damage [3], but even when the underlying pathological cause is ischemic it has proved difficult to identify a single mechanism. The traditional common teaching of local occlusion promoted by diabetes and hypertension is not supported by epidemiological evidence, as hypertension and diabetes are no more common in lacunar than in non lacunar strokes [4][5][6]. On the other hand, Miller Fisher himself admitted and postulated that some of his cases might have been due to embolism, mainly on the basis of the patency of the arteries supplying the infarcted tissue [1].…”