title: Lacunar Syndromes--Where is the Lesion?
abstract: OBJECTIVE
  The study aimed to evaluate different imaging localizations of the classical Lacunar syndromes, including multiplicity of lacunes.
  
  
  METHODS
  This prospective study was conducted in a tertiary care municipal hospital over 2 years. Patients with clinical Lacunar syndromes, confirmed on imaging, were evaluated for etiopathogenetic factors, lesion localization, and presence of multiple simItaneous lacunes. Angiographic data and cognitive evaluation was done in a subset of the cohort.
  
  
  RESULTS
  82 patients were studied, 12 undergoing DSA and 46 being evaluated cognitively. Commonest risk factors were Hypertension (97%) and tobacco usage (62%). Pure motor stroke (PMS-70.7%) was the commonest lacunar syndrome, Internal capsular lesions accounting for 53.4% of this syndrome. Among PMS, localisation to Carotid territory was seen in 84.4%, to vertebrobasilar territory in 10.3% and to both in 5.1% of patients. Sensorimotor lacunar syndrome was seen in 14.6% patients, half of them having a thalamic lesion. Overall, 17% patients had multiple simultaneous lacunes, over half of these being cortical, and multiplicity being seen in PMS most commonly. Of 46 patients tested for cognition, 69.5% showed significantly low scores on ACER, with a significant association with multiplicity of lacunes in this group.
  
  
  CONCLUSIONS
  In our study, Pure motor stroke was the commonest lacunar syndrome, 84% of PMS being due to Anterior circulation stroke. Multiple lacunes of similar age were seen in 17% patients, the predominantly cortical localization of these raising a possibility of embolism. Postlacunar stroke executive dysfunction was seen in over two-thirds of our patients.
authors.forename: Uma
authors.initials: U
authors.lastname: Sundar
authors.forename: Vijay
authors.initials: V
authors.lastname: Ghuge
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D013577:Syndrome