Stroke, Vol 23, 325-327, Copyright © 1992 by American Heart Association
DR Horowitz, S Tuhrim, JM Weinberger and SH Rudolph
BACKGROUND AND PURPOSE: Lacunes are thought to occur in patients with
hypertension or diabetes mellitus as a result of small-vessel disease. This
study evaluated the importance of other stroke mechanisms in a population
of patients with lacunar infarction. METHODS: We evaluated 108 consecutive
patients with a lacune in the lenticulostriate distribution for other
stroke risk factors such as carotid and cardiac disease. RESULTS:
Hypertension was present in 68% of the patients and diabetes mellitus in
37%; both occurred in 28% and neither occurred in 23%. Noninvasive carotid
studies identified atherosclerotic plaque as a possible embolic source in
23%. By previously established criteria, 18% were at high risk for
cardioembolism. Of those with hypertension or diabetes mellitus, 36% were
at risk for a carotid or cardiac embolus. Of those without hypertension or
diabetes mellitus, 32% had a possible carotid or cardiac etiology.
CONCLUSIONS: The high incidence of carotid and cardiac disease in those
with and without hypertension or diabetes mellitus suggests the importance
of other stroke mechanisms in this population. Patients with lacunar
infarction should therefore be evaluated for other causes of stroke that
may be treatable.
ARTICLES
Mechanisms in lacunar infarction
Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029.
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