title: Diagnostic accuracy and risk factors of the different lacunar syndromes.
abstract: BACKGROUND
  The lacunar syndrome is characterized by pure motor, pure sensory, or sensorimotor hemisymptoms without cortical deficits. It may be less predictable for a lacunar infarct (LI) than previously believed. The aims of the present study were to evaluate the diagnostic accuracy of the different lacunar syndromes and investigate factors associated with acute LI on diffusion-weighted imaging (DWI).
  
  
  METHODS
  Consecutive patients presenting with an acute lacunar syndrome who were admitted to the stroke unit were enrolled. The patients were examined clinically and underwent magnetic resonance imaging. The sensitivity and specificity of the different lacunar syndromes were assessed using DWI as reference test, and we estimated positive and negative predictive values. Patients were divided into a LI group and a group without LI. Between-group differences were analyzed by χ(2) test, t test, and Mann-Whitney U test, as appropriate. Logistic regression was performed to analyze predictors of LI. Candidate variables were pure motor syndrome, age, gender, hypertension, precerebral or intracerebral stenosis, atrial fibrillation, diabetes, coronary heart disease, and smoking.
  
  
  RESULTS
  Eighty-six patients with lacunar syndrome underwent DWI. The positive predictive value of the lacunar syndrome was 65.1% and 75% for the pure motor syndrome. Of the candidate variables, only pure motor syndrome and male gender had significant associations with LI on imaging.
  
  
  CONCLUSIONS
  The clinical diagnosis of patients with lacunar syndromes is inaccurate, especially among patients with sensorimotor syndrome. DWI is mandatory for obtaining an accurate diagnosis of the infarct.
authors.affiliation: Medical Division, Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: marianne.altmann@ahus.no.
authors.forename: Marianne
authors.initials: M
authors.lastname: Altmann
authors.affiliation: Medical Division, Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Bente
authors.initials: B
authors.lastname: Thommessen
authors.affiliation: Medical Division, Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Ole Morten
authors.initials: OM
authors.lastname: Rønning
authors.affiliation: Medical Division, Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Antje S
authors.initials: AS
authors.lastname: Reichenbach
authors.affiliation: Specialist Health Section, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Brynjar
authors.initials: B
authors.lastname: Fure
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019957:Motor Skills Disorders / Q000175:diagnosis* / Q000473:pathology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D059409:Stroke, Lacunar / Q000175:diagnosis* / Q000473:pathology
keywords: Lacunar syndrome; acute stroke; cerebral infarction; diagnostic accuracy; diffusion-weighted MRI; lacunar infarct