Clinical lacunar syndromes as predictors of lacunar infarcts. A comparison of acute clinical lacunar syndromes and findings on diffusion-weighted MRI.
OBJECTIVE
To evaluate if patients with acute lacunar syndromes have acute lacunar infarcts or other types of cerebral lesions on diffusion-weighted MRI.


METHODS
Patients with acute lacunar syndromes underwent echo-planar diffusion MRI of the brain within 3 days after stroke onset. Localization and size of lesions with hyperintense signal were determined, compared with clinical characteristics and with findings on follow-up T2-weighted MRI.


RESULTS
Twenty-three patients participated in the study. Thirteen patients had pure motor stroke, 1 pure sensory stroke, 8 sensorimotor stroke, and 1 ataxic hemiparesis. Twenty-two patients had at least one lesion with increased signal on diffusion-weighted MR images. These acute lesions were in the internal capsule/ basal ganglia/thalamus in 13 patients, subcortical white matter in 5 patients, brainstem in 2 patients, cortex (multiple small lesions) in 1 patient, and cortex + basal ganglia in 1 patient. The median volume of the lesions was 0.6 ml on the initial examination and on follow-up, of 17 patients after 1 to 5 months, 0.5 ml.


CONCLUSIONS
Almost all patients with acute ischemic lacunar syndromes have acute lesions on echo-planar diffusion-weighted MRI within 3 days after stroke onset. These lesions are mostly small and subcortical, compatible with lacunar infarcts caused by single penetrating artery occlusion, but in a minor proportion of patients (2 of 23 in our study) a cortical involvement is found.
Lindgren
A
A
Department of Neurology, University Hospital, Lund, Sweden.
Staaf
G
G
Geijer
B
B
Brockstedt
S
S
Ståhlberg
F
F
Holtås
S
S
Norrving
B
B
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001479:Basal Ganglia / Q000098:blood supply / Q000473:pathology; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D020772:Internal Capsule / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology / Q000473:pathology*; D013577:Syndrome; D013788:Thalamus / Q000098:blood supply / Q000473:pathology