title: Need for extensive diagnostic work-up for patients with lacunar stroke.
abstract: OBJECTIVE
  Small-vessel disease is the most frequent cause of lacunar stroke. The aims of this study were to evaluate: 1) alternative causes of lacunar stroke other than small-vessel disease; 2) functional outcome of lacunar strokes due to small vessel disease compared to lacunar strokes due to alternative causes.
  
  
  METHODS
  Consecutive patients with first-ever ischemic lacunar stroke were prospectively followed-up for at least 3 months. At discharge patients were divided into 2 groups: lacunar stroke due to small vessel disease (L-SVD) and lacunar stroke due to possible other etiologies (L-non SVD) (e. g. cardioembolism, atherosclerosis or other causes). Main outcome measures were the combined end point of death or disability (mRS >or= 3) and recurrent stroke at the end of follow-up.
  
  
  RESULTS
  535 patients with acute stroke were seen during the study period. Out of these, 196 patients (126 males) with a mean age of 71.6 years (SD = 10) had lacunar stroke. L-SVD was seen in 142 patients (72.4 %) and L-nonSVD in 54 patients (27.6 %). After 16.4 months, 12 patients had died (6.2%; annual mortality rate 4.4 %), 63 were disabled (32.5 %) and 27 had stroke recurrence (13.9%; annual recurrence rate 9.9 %). Forty-nine patients with L-SVD (34.7 %) and 26 with L-nonSVD (49%) had died or become disabled. Sixteen patients with L-SVD (11.3 %) and 11 with L-nonSVD (20.4 %) had stroke recurrence. On multivariate analysis, L-nonSVD (OR = 2.87, 95% CI 1.08-7.65; p = 0.034) and age (OR = 1.07, 95 % CI 1.02-1.12; p = 0.01) were associated to more severe outcome. L-nonSVD was independently associated with recurrence (OR = 5.03, 95% CI 1.54-16.44; p = 0.006).
  
  
  CONCLUSIONS
  Twenty-seven percent of patients with lacunar stroke have causes other than small vessel disease. These patients have a severe outcome in terms of recurrence,mortality or disability. These findings support the need for a comprehensive diagnostic work-up for patients with lacunar stroke.
authors.affiliation: Stroke Unit, Dept. of Cardiovascular Medicine, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06128 Perugia, Italy. saramicheli@hotmail.it
authors.forename: Sara
authors.initials: S
authors.lastname: Micheli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Palmerini
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
authors.forename: Michele
authors.initials: M
authors.lastname: Venti
authors.forename: Andrea
authors.initials: A
authors.lastname: Alberti
authors.forename: Sergio
authors.initials: S
authors.lastname: Biagini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D020520:Brain Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology; D002941:Circle of Willis / Q000473:pathology / Q000503:physiopathology; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate