Computed tomographic changes in lacunar syndromes.
BACKGROUND
Lacunes are small deep infarcts due to occlusion of long-perforating arterial branches. The clinical presentation and outcome are variable. The present study investigates the prognostic value of comparing repeated computed tomographic (CT) scans in patients with a lacunar syndrome (LACS).


METHODS
From a series of 220 patients, subsequently admitted with a first-ever stroke, 32 were diagnosed as LACS. CT scans without contrast enhancement were performed on day 3 and 10 after onset of the symptoms. A lacune was considered as responsible for the LACS when its location corresponded to the expected cerebral hemisphere and when it changed in size and/or in X-ray attenuation on the CT scans from day 3 to 10. The size of the lacune was also measured and compared on both time points. The patients were divided into two groups according to the modified Rankin (R) scale at 3 months, in those who were independent (R 0-1-2) and in those who remained handicapped (R 3-4-5).


RESULTS
The patients who remained disabled at 3 months were older and more severely impaired on admission, and had more frequent cardiac problems and cognitive decline than the independent ones. On CT scans of the brain a higher incidence of leukoaraiosis was observed in this group. Only in three patients of each group no relevant lacune could be observed both on day 3 and 10. The average size of the symptomatic lacune on day 3 and 10 was not statistically different between both groups, when comparing all patients with a LACS. When comparing only those patients with a visible symptomatic lacunar infarct on one of the CT scans, however, the average size of the symptomatic deep infarct was smaller in the independent than the handicapped patients on day 3 as well as on day 10. The lacune decreased in average size from day 3 to 10 in the former group but remained unchanged in the group of disabled patients.


CONCLUSIONS
The outcome of patients with a LACS depends on several factors including age, cognitive and cardiac status, the presence of leukoaraiosis and also the size of the symptomatic lacune.
De Reuck
Jacques
J
Department of Neurology, University Hospital, Ghent, Belgium. jacques.dereuck@yucom.be
Hemelsoet
Dimitri
D
Nieuwenhuis
Lotte
L
Van Maele
Georges
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000523:psychology; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013577:Syndrome; D013997:Time Factors; D014057:Tomography, X-Ray Computed