Cavitation of deep lacunar infarcts in patients with first-ever lacunar stroke: a 2-year follow-up study with MR.
OBJECTIVE
Studies in patients with lacunar stroke often assess the number of lacunes. However, data on how many symptomatic lacunar infarcts cavitate into a lacune are limited. We assessed the evolution of symptomatic lacunar infarcts over 2-year follow-up.


METHODS
In 82 patients with first-ever lacunar stroke with a lacunar infarct in the deep brain regions (excluding the centrum semiovale), we performed a brain MR at presentation and 2 years later. We classified cavitation of lacunar infarcts at baseline and on follow-up MR as absent, incomplete, or complete. We recorded time to imaging, infarct size, and vascular risk factors.


RESULTS
On baseline MR, 38 (46%) index infarcts showed complete or incomplete cavitation. Median time to imaging was 8 (0-73) days in noncavitated and 63 (1-184) days in cavitated lesions (P<0.05). On follow-up imaging, 94% of the lacunar infarcts were completely or incompletely cavitated, most had reduced in diameter, and 5 (6%) had disappeared. Vascular risk factors were not associated with cavitation.


CONCLUSIONS
Cavitation and lesion shrinkage were seen in almost all symptomatic lacunar infarcts in the deep brain regions over 2-year follow-up. Counting lacunes in these specific regions at a random moment might slightly, however not substantially, underestimate the burden of deep lacunar infarction.
Department of Neurology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, University Maastricht, The Netherlands. c.loos@mumc.nl
Caroline M J
CM
Loos
Julie
J
Staals
Joanna M
JM
Wardlaw
Robert J
RJ
van Oostenbrugge
D000368:Aged; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020772:Internal Capsule / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011149:Pons / Q000473:pathology; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000150:complications