A prospective evaluation of the utility of clinical data in distinguishing acute large vessel from lacunar cerebral infarctions.
A stroke registry of 290 patients was developed to determine the value of various clinical data in discriminating acute large vessel from lacunar infarctions. Clinical or computed tomography (CT) localization was achieved in 98% of patients with infarcts. Among 216 localizable supratentorial infarcts, CT demonstrated the responsible lesion in 22 of 54 lacunes (42%) and 109 of 162 large vessel infarcts (67%). History provided the basis for localization, i.e., distinction between large vessel and lacunar events, in 74% with 88% sensitivity and 59% specificity; higher cortical function examination in 88% with 96% sensitivity and 74% specificity; neurologic examination in 79% with 72% sensitivity and 75% specificity; graphes-thesia in 57% with 63% sensitivity and 89% specificity; and EEG in 76% with 71% sensitivity and 100% specificity.
From the Geriatric Research, Education and Clinical Center, Veterans Administration Medical Center, and the Department of Neurology, University of Florida College of Medicine, Gainesville, FL.
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Nadeau
Bay Pines Veterans Administration Medical Center, St. Petersburg, and the Department of Neurology, University of South Florida, Tampa, FL.
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Jordan
The Veterans Administration Outpatient Clinic,and the Department of Neurology, University of Southern California, Los Angeles, Los Angeles, CA, U.S.A.
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Mishra