Imaging evolution of acute lacunar infarction

Background and Purpose-Previous studies in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy showed that accumulation of lacunes strongly relate to clinical severity. However, the potential predictors of incident lacunes and their clinical consequences over a short time frame have not been investigated. This study aimed to determine the predictors and clinical impact of such lesions in a large cohort of patients. Methods-Two hundred and six NOTCH3 mutation carriers (mean age, 49.5±10.6 years) were followed up over 3 years.Incident lacunes were identified using difference imaging from 3-dimensional T1 images. Clinical events and change in different clinical scores such as the Mattis Dementia Rating Scale, Modified Rankin Scale, Barthel index, and time to complete part A and part B of Trail Making Test were recorded. Associations were analyzed with multivariable logistic regression analysis and ANCOVA. Results-Over a mean period of 3.4±0.7 years, incident lacunes occurred in 51 of 206 patients. Both the number of lacunes (P<0.0001) and systolic blood pressure at baseline (P<0.01) were independent predictors of incident lacunes during follow-up. The results were still significant after excluding patients with systolic blood pressure >140 mm Hg. Incident lacunes were also associated with incident stroke and with change in time to complete Trail Making Test part B, initiation/ perseveration subscale of the Mattis Dementia Rating Scale and Barthel Index over the study period. Conclusions-Systolic blood pressure and the number of prevalent lacunes are independent predictors of incident lacunes in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. These lesions mainly impact executive performances and functional independence over 3 years.

Section: Discussionmentioning

confidence: 92%

Predictors and Clinical Impact of Incident Lacunes in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy

Ling

Guio

Duering

et al. 2017

“…In another study, cavitation was seen on 23 of 38 MRI (61%) and 50 of 70 CT (70%). 20 There were some methodological limitations of these previous studies, however. The timing of follow-up ranged widely (6 days to Ͼ4 years) 11,20 because follow-up was nonconsecutive and done for clinical indications, raising the possibility of bias.…”

Section: Moreau Et Al Cavitation After Acute Lacunar Infarctionmentioning

confidence: 92%

“…11,20 In 1 study, only 25 of 90 patients (28%) showed evidence of evolution into a cavitated lesion, including only 14 of 33 (42%) of patients with an MRI-confirmed acute infarct and a follow-up MRI. 11 Longer time to follow-up was associated with an increased likelihood of cavitation (median time 228 days in patients with cavitation versus 72 days in patients without cavitation), similar to our study.…”

Section: Moreau Et Al Cavitation After Acute Lacunar Infarctionmentioning

confidence: 97%

Cavitation After Acute Symptomatic Lacunar Stroke Depends on Time, Location, and MRI Sequence

Moreau

Patel

Lauzon

et al. 2012

Background and Purpose-Definitions for chronic lacunar infarcts vary. Recent retrospective studies suggest that many acute lacunar strokes do not develop a cavitated appearance. We determined the characteristics of acute lacunar infarcts on follow-up MRI in consecutive patients participating in prospective research studies. Methods-Patients with acute lacunar infarction on diffusion-weighted imaging were selected from 3 prospective cohort studies of minor stroke imaged within Ͻ24 hours of onset. ). Evidence of cavitation on MRI was rated separately on fluid-attenuated inversion recovery, T1, and T2 sequences by 2 independent study physicians; discrepant readings were resolved by consensus. Results-Probable or definite cavitation on any sequence was more common at 90 days compared with 30 days (PՅ0.001 for all sequences). At 90 days, evidence of cavitation was seen on at least 1 sequence in 33 of 34 patients (97%). The T1-weighted sequence was most sensitive to the presence of cavitation (94% at 90 days). By contrast, the fluid-attenuated inversion recovery sequence frequently failed to show evidence of cavitation in the brain stem or thalamus (only 10 of 18 [56%] showed cavitation). Conclusions-MRI scanning at 90 days with T1-weighted imaging reveals evidence of cavitation in nearly all cases of acute lacunar infarction. By contrast, reliance on fluid-attenuated inversion recovery alone will miss many cavitated lesions in the thalamus and brain stem. These factors should be taken into account in the development of standardized criteria for lacunar infarction on MRI. (Stroke. 2012;43:1837-1842.)

“…This is consistent with another study assessing evolution of lacunar infarcts, indicating that acute DWI lesions overestimate the final infarct volume by 40%. 6 In the patients with complete DWI reversal, we cannot exclude the possibility that no tissue was actually infarcted at the time of baseline MRI scans. Alternatively, it may be that the true final infarct volume is actually not zero in most of these patients.…”

Section: Discussionmentioning

confidence: 98%

Dynamic Evolution of Diffusion-Weighted Imaging Lesions in Patients With Minor Ischemic Stroke

Kate

Riaz

Gioia

et al. 2015