Computed tomographic changes in lacunar syndromes

• Published in: Clinical neurology and neurosurgery 2005-12, Vol.108 (1), p.18-24
• Main Authors: De Reuck, Jacques, Hemelsoet, Dimitri, Nieuwenhuis, Lotte, Van Maele, Georges
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Brain; Brain Infarction - complications; Brain Infarction - diagnostic imaging; Brain Infarction - psychology; Disability Evaluation; Disease Progression; Family medical history; Female; Follow-Up Studies; Humans; Lacunar size on CT-stroke outcome; Lacunar syndromes; Male; Medical sciences; Middle Aged; Neurology; Neurosurgery; Prognosis; Prospective Studies; Small deep infarcts; Stroke; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Syndrome; Time Factors; Tomography, X-Ray Computed
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2004.12.022

Lacunes are small deep infarcts due to occlusion of long-perforating arterial branches. The clinical presentation and outcome are variable. The present study investigates the prognostic value of comparing repeated computed tomographic (CT) scans in patients with a lacunar syndrome (LACS). From a series of 220 patients, subsequently admitted with a first-ever stroke, 32 were diagnosed as LACS. CT scans without contrast enhancement were performed on day 3 and 10 after onset of the symptoms. A lacune was considered as responsible for the LACS when its location corresponded to the expected cerebral hemisphere and when it changed in size and/or in X-ray attenuation on the CT scans from day 3 to 10. The size of the lacune was also measured and compared on both time points. The patients were divided into two groups according to the modified Rankin (R) scale at 3 months, in those who were independent (R 0-1-2) and in those who remained handicapped (R 3-4-5). The patients who remained disabled at 3 months were older and more severely impaired on admission, and had more frequent cardiac problems and cognitive decline than the independent ones. On CT scans of the brain a higher incidence of leukoaraiosis was observed in this group. Only in three patients of each group no relevant lacune could be observed both on day 3 and 10. The average size of the symptomatic lacune on day 3 and 10 was not statistically different between both groups, when comparing all patients with a LACS. When comparing only those patients with a visible symptomatic lacunar infarct on one of the CT scans, however, the average size of the symptomatic deep infarct was smaller in the independent than the handicapped patients on day 3 as well as on day 10. The lacune decreased in average size from day 3 to 10 in the former group but remained unchanged in the group of disabled patients. The outcome of patients with a LACS depends on several factors including age, cognitive and cardiac status, the presence of leukoaraiosis and also the size of the symptomatic lacune.