Identification of Embolic Stroke Patterns by Diffusion-Weighted MRI in Clinically Defined Lacunar Stroke Syndromes

Abstract

Background-A number of clinical syndromes describing the presentation of deep brain infarcts are called lacunar syndromes resulting from small vessel occlusion (SVO). To verify the reliability of the clinical diagnosis "lacunar syndrome," the value was investigated with diffusion-weighted MRI (DWI). Methods and Results-A total of 73 patients (mean age 66 years; range 35 to 83 years) with sudden onset of a classical lacunar syndrome were enrolled. On the basis of the DWI findings, patients were divided into 3 groups: group 1, single subcortical lesion (Ͻ15-mm lesion; 43 patients; 59%); group 2, large (Ն15 mm) or scattered lesions in 1 vascular territory (16 patients; 22%); and group 3, multiple lesions in multiple vascular territories (14 patients; 19%). A stroke mechanism other than SVO could be identified in 17 (23%) patients. Cardiac work-up revealed a cardiac embolic source in 8 patients (11%). Duplex sonography revealed symptomatic stenosis in 9 patients (12%). Based on the work-up information, 29 patients (40%) were found to have a potential cause of stroke other than SVO. A significant correlation with Ͼ1 single lesion on DWI-MRI and a clinical proven embolic source was observed (Pϭ0.002). In 9 patients with MRI suspicious for a pathomechanism other than SVO, no embolic source was found. Conclusions-The

Estimating cerebral microinfarct burden from autopsy samples

“…7,8,[21][22][23] These neuroimaging results are subject to their own potential for overestimation or underestimation, however, such as DWI-MRI's limited spatial (approximately 1 to 2 mm diameter) and temporal (within days of acute infarction) resolution. Our estimates of total microinfarct burden will therefore ultimately require systematic (and labor-intensive) sampling of entire brains using modern stereologic techniques.…”

Multimodal CT Provides Improved Performance for Lacunar Infarct Detection

“…8 Inaccuracy of the LI diagnosis is present in approximately 30% of stroke presentations by using clinical and NCCT findings alone. 9 CTP is increasingly used during acute stroke work-up due to its cost effectiveness, ease, availability, speed, and tolerability. 10 CTP significantly improves sensitivity for detection of infarcts overall compared with NCCT alone.…”

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

“…Therefore, even in recent textbooks [7] the precise etiological interpretation remains doubtful, although it is often suggested that cardiogenic embolism is a very rare cause of lacunar syndromes [2,4,5]. Contrary to this assumption Wessel et al, by systematically investigating patients with DWI-MRI, found that 14 (19%) out of 73 patients with lacunar syndromes had multiple recent lesions in different areas, thus suggesting cardiac embolism as the likely cause [8], although they only reported atrial fibrillation as potential embolic source in 3 patients. More recently Ueno et al [9] included RLS as a potential cardiac source of emboli and found that compared with the 32% prevalence found in healthy controls, lacunar patients had a significantly higher 41% prevalence when hypertension and/or diabetes were present and a still higher 82% prevalence when neither risk factor was present.…”