Long-term prognosis of symptomatic lacunar infarcts. A hospital-based study.

Abstract

This study concerns the long-term prognosis of lacunar infarcts. We report the analysis of our hospital-based series of 178 patients consecutively admitted for a lacunar syndrome due to a lacunar infarct diagnosed with computed tomography and magnetic resonance imaging. Demographic data, medical history, vascular risk factors, and imaging data were recorded for each patient. The follow-up was 35 +/- 22 months. The lacunar syndrome was pure motor hemiparesis in 69 patients (39%), ataxic hemiparesis in 45 patients (25.4%), pure sensory stroke in 15 patients (8.5%), sensorimotor stroke in 14 patients (7.9%), and miscellaneous syndrome in 34 patients (19.2%). The 4-year survival rate was 80 +/- 4% and the 4-year survival rate without recurrent stroke was 85 +/- 3.5%. Using Cox proportional-hazards analysis, the predictors of death were age (P < .02), diabetes mellitus (P < .05), and cigarette smoking (P < .05). We did not find any predictors of recurrence. After 1 year, 74% of the patients had mild or no disability. Using logistic regression analysis, the predictive factors of disability were age more than 70 years (P < .01), diabetes (P < .01), history of stroke or transient ischemic attack (P < .05), and type of lacunar syndrome (P < .01). Imaging data, number of lacunes, and presence of leukoaraiosis were not predictors of outcome. Our study suggests that with a high survival rate, a low recurrence rate, and a relatively good functional recovery, lacunar infarcts have a relatively favorable prognosis.

Pure Motor Stroke From Presumed Lacunar Infarct: Long-Term Prognosis for Survival and Risk of Recurrent Stroke

“…In our study hypertension and diabetes were independent predictors for recurrent stroke, in contrast to previous studies in which either no single factor 15,18 or age only 23 was found. The adequacy of risk factor management and compliance to therapy during follow-up was not addressed in our study.…”

“…Previously reported independent risk factors for death after lacunar infarction are age, diabetes, and smoking (in the study by Clavier et al 15 ) and age and disability score (in the study by Salgado et al 18 ). The high proportion of our patients (54%) not prescribed ASA at discharge from hospital reflects the therapeutic tradition in the mid-1980s, before the wide acceptance of antiplatelet therapy as standard therapy in different thromboembolic disorders.…”

“…However, several studies are based on small numbers of patients and have limited statistical precision; only 1 previous study was based on Ͼ150 patients. 15 Methodological features may also contribute to differences between studies. Moreover, times of follow-up have been relatively short in most studies.…”

“…4 Several clinical aspects of lacunar infarcts have been well studied, eg, risk factors, initial clinical features, and short-term prognosis for survival and stroke recurrence. [1][2][3][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] However, the long-term prognosis is less well documented, mainly because the follow-up periods have been limited to Յ5 years, and considerable uncertainty exists about which putative risk factors are independent determinants of survival and recurrent stroke for patients with this subtype of stroke. 15,18,22,23 To address these issues, we examined prognostic features and determinants for survival and stroke recurrence in 178 patients with pure motor stroke from presumed lacunar infarct, followed up to 10 years after stroke onset.…”

Diabetes Impairs Cortical Plasticity and Functional Recovery Following Ischemic Stroke

“…A second common principle is that certain stroke comorbidities are strongly associated with poor neurological outcome. In particular, clinical studies have shown that diabetes increases the risk of ischemic stroke and is associated with slower or poorer recovery of function/independence (Clavier et al, 1994;Jorgensen et al, 1994;Hankey et al, 2007;Kamouchi et al, 2011), even when adjusting for confounding factors such as age and stroke severity (Wei et al, 2010).…”