Computed tomography and pure motor hemiparesis

Weisberg, Leon A.

doi:10.1212/wnl.29.4.490

Cited by 84 publications

(38 citation statements)

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“…1 We attribute the low percentage of positive correlation between CT and lacunes to the small size of the brain lesions (<32 mm) and to the effect of the bony artifacts that, in the posterior fossa, frequently interfere with the visualization of small brain stem lesions. 43 - 44 Associated lacunes existed in 11% of our patients, a figure lower than the 38% reported by others. 45 The existence of associated vascular lesions in patients with symptomatic lacunes is not surprising as several clinicopathologic studies have shown that most lacunes are multiple and that many are asymptomatic.…”

Section: Discussioncontrasting

confidence: 79%

Clinical study of 227 patients with lacunar infarcts.

Arboix

Martí-Vilalta

García

1990

Stroke

179

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We describe an analysis of 227 patients with lacunar infarcts; 177 were inpatients and the remaining 50 were outpatients. The group comprised 11% of all inpatients with cerebrovascular pathology and 16% of all consecutive inpatients with brain infarcts studied at the Department of Neurology of the Hospital de la Santa Creu i Sant Pau. The main risk factors identified in these patients were arterial hypertension in 164 (72%), diabetes mellitus in 64 (28%), and heart disease in 58 (26%). The most common clinical syndromes were pure motor hemiparesis in 125 (55%), pure hemisensory stroke in 42 (18%), the sensorimotor deficit syndrome in 34 (15%), ataxic hemiparesis in seven (3%), and the dysarthria-clumsy hand syndrome in four (2%); atypical syndromes were observed in 15 patients (7%). Lacunes were demonstrated by computed tomography in 100 patients (44%) and by magnetic resonance imaging in 35 (78%) of the 45 patients in which it was applied. Magnetic resonance imaging was significantly better (p< 0.001) than computed tomography for imaging lacunes, especially those located in either the pons (p<0.005) or the internal capsule (/xO.001). After the acute phase, mild or no neurologic disability was detected in 178 patients (78.4%), moderate disability persisted in 48 patients (

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Section: Discussioncontrasting

confidence: 79%

Clinical study of 227 patients with lacunar infarcts.

Arboix

Martí-Vilalta

García

1990

Stroke

179

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“…In this present study hypertension was less frequently found and angiography revealed evidence of atheromatous thrombo-embolism in several cases. That the same clinical picture of a small deep infarct can be seen with small vessel disease in the hypertensive (Fisher, 1969) and with disease of the carotid and middle cerebral artery (Weisberg, 1979) is clearly important in the management of such patients. The clinical picture of a lacunar stroke should perhaps not deter investigation by angiography if bruits or non-invasive investigation suggests the presence of neck vessel disease.…”

Section: Discussionmentioning

confidence: 91%

Clinical distinction of cerebral haemorrhage and cerebral infarction

Harrison

1980

Postgraduate Medical Journal

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The clinical features of 62 cases of computerized axial tomography scan-proved cerebral haemorrhage and 81 cases of cerebral infarction in the carotid territory have been compared in a retrospective case note survey. The clinical features which can help in making the distinction between haemorrhage and infarction at the bedside are discussed and compared with those of classical teaching which referred only to post-mortem proved cases.

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“…The site of the lesion does not precisely determine its pathogenesis as infarction, hemorrhage, infection, 23 or neoplasm. 24 CT has established that small intracerebral hemorrhages 25 - 26 and large ischemic infarcts 27 can cause "lacunar syndromes." The cause(s) of "lacunar syndromes" have strayed so far from stroke as to include cysticercosis.…”

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confidence: 99%

The fallacy of the lacune hypothesis.

Millikan

Futrell

1990

Stroke

153

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We review the definition, pathogenesis, natural history, and prognosis and describe the first experimental model of lacunes. Defined pathologically or radiologically, lacunes are small cerebral infarcts which become cystic and are caused by occlusion of small arteries. The clinical definition of lacune is confused. The word "lacune" means a small stroke. While the immediate mortality rate from a small stroke is low, many patients are unable to return to work and the long-term prognosis is guarded. Photochemical damage to the carotid artery of rats produces microemboli to the brain, resulting in cavitary lesions resembling lacunes in humans. The "lacune hypothesis" is a fallacy because small cerebral infarcts are not caused solely by a combination of hypertension and small vessel disease, and the various "lacunar syndromes" are simply small strokes which should be investigated as such. (Stroke 1990;21:1251-1257) T he "lacune hypothesis" states that lacunes are caused by a combination of hypertension and characteristic vascular lesions involving single perforating brain arteries.

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Computed tomography and pure motor hemiparesis

Cited by 84 publications

References 0 publications

Clinical study of 227 patients with lacunar infarcts.

Clinical study of 227 patients with lacunar infarcts.

Clinical distinction of cerebral haemorrhage and cerebral infarction

The fallacy of the lacune hypothesis.

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