Stroke, Vol 22, 175-181, Copyright © 1991 by American Heart Association
A Chamorro, RL Sacco, JP Mohr, MA Foulkes, CS Kase, TK Tatemichi, PA Wolf, TR Price and DB Hier
Lacunar stroke was diagnosed in 337 (26%) of the 1,273 patients with
cerebral infarction among the 1,805 total in the Stroke Data Bank. We
analyzed the 316 patients with classic lacunar syndromes. Among these, 181
(57%) had pure motor hemiparesis, 63 (20%) sensorimotor syndrome, 33 (10%)
ataxic hemiparesis, 21 (7%) pure sensory syndrome, and 18 (6%)
dysarthria-clumsy hand syndrome. No striking differences were found among
the risk factors for the lacunar subtypes, but differences were found
between lacunar stroke as a group and other types of infarcts. Compared to
113 patients with large-vessel atherosclerotic infarction, those with
lacunar stroke had fewer previous transient ischemic attacks and strokes.
Compared to 246 with cardioembolic infarction, patients with lacunar stroke
more frequently had hypertension and diabetes and less frequently had
cardiac disease. We found a lesion in 35% of the lacunar stroke patients'
computed tomograms, with most lesions located in the internal capsule and
corona radiata. The mean infarct volume was greater in patients with pure
motor hemiparesis or sensorimotor syndrome than in those with the other
lacunar stroke subtypes. In patients with pure motor hemiparesis and
infarcts in the posterior limb of the internal capsule, there was a
correlation between lesion volume and hemiparesis severity except for the
few whose infarct involved the lowest portion of the internal capsule; in
these patients severe deficits occurred regardless of lesion volume. Taken
together, the computed tomographic correlations with the syndromes of
hemiparesis showed only slight support for the classical view of a
homunculus in the internal capsule.
ARTICLES
Clinical-computed tomographic correlations of lacunar infarction in the Stroke Data Bank
Neurological Institute of New York, Columbia-Presbyterian Medical Center, New York, N.Y.
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