(Stroke. 1996;27:842-846.)
© 1996 American Heart Association, Inc.
Articles |
Functional Outcome in Patients With Lacunar Infarction
From the Department of Neurology, Örebro Medical Center Hospital (M.S., G.B.O.), and the Department of International Health and Social Medicine, Karolinska Institute, Stockholm (B.S.), Sweden.
Correspondence to Margareta Samuelsson, MD, Department of Neurology, Örebro Medical Center Hospital, S-701 85 Örebro, Sweden.
Background and Purpose Little is known about the prognosis and the predictive factors for functional outcome after lacunar infarction. Our aim was to analyze this issue in more detail and with a longer follow-up than in previous reports.
Methods Functional outcome was assessed in 81 consecutive patients with a first-ever stroke and clinical and MRI findings compatible with lacunar infarction. We measured impairment (motor, sensory, and cognitive function), disability (Katz's Index of Activities of Daily Living [ADL] and four instrumental activities), and handicap (Oxford Handicap Scale). The patients were followed up for 3 years.
Results During follow-up, 6% of the patients died and 21% had recurrent strokes, mostly new lacunar infarcts. A fast initial recovery was found in most patients. At 1 year, 12% were dependent in personal ADL, which after 3 years had increased to 24%, mostly as a result of the effects of recurrent strokes. In a logistic multivariate regression model, moderate or severe hemiparesis 1 month after stroke onset was the strongest predictor of physical dependence or death at 3 years (P<.001), followed by white matter hyperintensities on MRI (P<.01). Age, vascular risk factors, and recurrent stroke were not statistically significant independent predictors of functional outcome.
Conclusions Functional outcome regarding physical independence was favorable in most patients. Motor impairment and white matter disease were the strongest predictors of a poor functional outcome. Recurrent stroke increased disability and handicap but was not a statistically significant independent risk factor. Measurements of personal ADL alone were insensitive in detecting the consequences of stroke in many patients with preserved self-care ability, who still experienced disability and handicap.
Key Words: activities of daily living • lacunar infarction • stroke outcome
This article has been cited by other articles:
 |
|
 |
|
  G. Jickling, A. Salam, A. Mohammad, M. S. Hussain, J. Scozzafava, A. M. Nasser, T. Jeerakathil, A. Shuaib, and R. Camicioli Circulating Endothelial Progenitor Cells and Age-Related White Matter Changes Stroke, October 1, 2009; 40(10): 3191 - 3196. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Kissela, C. J. Lindsell, D. Kleindorfer, K. Alwell, C. J. Moomaw, D. Woo, M. L. Flaherty, E. Air, J. Broderick, and J. Tsevat Clinical Prediction of Functional Outcome After Ischemic Stroke: The Surprising Importance of Periventricular White Matter Disease and Race Stroke, February 1, 2009; 40(2): 530 - 536. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Simpkins, E. Perez, Xiaofei Wang, ShaoHua Yang, Yi Wen, and M. Singh The Potential for Estrogens in Preventing Alzheimer's Disease. Therapeutic Advances in Neurological Disorders, January 1, 2009; 2(1): 31 - 49. [Abstract] [PDF]
|
|
|
|
 |
|
 J. E. Schillerstrom, D. R. Royall, and R. F. Palmer Depression, Disability and Intermediate Pathways: A Review of Longitudinal Studies in Elders J Geriatr Psychiatry Neurol, September 1, 2008; 21(3): 183 - 197. [Abstract] [PDF]
|
|
|
|
 |
|
 B Norrving Lacunar infarcts: no black holes in the brain are benign Practical Neurology, August 1, 2008; 8(4): 222 - 228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Bejot, A. Catteau, M. Caillier, O. Rouaud, J. Durier, C. Marie, A. Di Carlo, G.-V. Osseby, T. Moreau, and M. Giroud Trends in Incidence, Risk Factors, and Survival in Symptomatic Lacunar Stroke in Dijon, France, From 1989 to 2006: A Population-Based Study Stroke, July 1, 2008; 39(7): 1945 - 1951. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Patel, K. Tilling, E. Lawrence, A. G. Rudd, C. D. A. Wolfe, and C. McKevitt Relationships between long-term stroke disability, handicap and health-related quality of life. Age Ageing, May 1, 2006; 35(3): 273 - 279. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Meijer, J van Limbeek, G Peusens, M Rulkens, K Dankoor, M Vermeulen, and R J de Haan The Stroke unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study Clinical Rehabilitation, July 1, 2005; 19(7): 770 - 778. [Abstract] [PDF]
|
|
|
|
 |
|
 J M Wardlaw What causes lacunar stroke? J. Neurol. Neurosurg. Psychiatry, May 1, 2005; 76(5): 617 - 619. [Full Text] [PDF]
|
|
|
|
|
|
V C T Mok, A Wong, W W M Lam, Y H Fan, W K Tang, T Kwok, A C F Hui, and K S Wong Cognitive impairment and functional outcome after stroke associated with small vessel disease J. Neurol. Neurosurg. Psychiatry, April 1, 2004; 75(4): 560 - 566. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Arauz, L. Murillo, C. Cantu, F. Barinagarrementeria, and J. Higuera Prospective Study of Single and Multiple Lacunar Infarcts Using Magnetic Resonance Imaging: Risk Factors, Recurrence, and Outcome in 175 Consecutive Cases Stroke, October 1, 2003; 34(10): 2453 - 2458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Meijer, D S Ihnenfeldt, I J. de Groot, J van Limbeek, M Vermeulen, and R J de Haan Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature Clinical Rehabilitation, February 1, 2003; 17(2): 119 - 129. [Abstract] [PDF]
|
|
|
|
|
|
D. W. Desmond, J. T. Moroney, M. Sano, Y. Stern, and J. G. Merino Incidence of Dementia After Ischemic Stroke: Results of a Longitudinal Study * Editorial Comment Stroke, September 1, 2002; 33(9): 2254 - 2262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. de Jong, F. Kessels, and J. Lodder Two Types of Lacunar Infarcts: Further Arguments From a Study on Prognosis Stroke, August 1, 2002; 33(8): 2072 - 2076. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Pettersen, T. Dahl, and T. B. Wyller Prediction of long-term functional outcome after stroke rehabilitation Clinical Rehabilitation, February 1, 2002; 16(2): 149 - 159. [Abstract] [PDF]
|
|
|
|
|
|
Y. Yamamoto, I. Akiguchi, K. Oiwa, M. Hayashi, T. Kasai, and K. Ozasa Twenty-four-Hour Blood Pressure and MRI as Predictive Factors for Different Outcomes in Patients With Lacunar Infarct Stroke, January 1, 2002; 33(1): 297 - 305. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Tilling, J. A.C. Sterne, A. G. Rudd, T. A. Glass, R. J. Wityk, and C. D.A. Wolfe A New Method for Predicting Recovery After Stroke Stroke, December 1, 2001; 32(12): 2867 - 2873. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Staaf, A. Lindgren, and B. Norrving Pure Motor Stroke From Presumed Lacunar Infarct: Long-Term Prognosis for Survival and Risk of Recurrent Stroke Stroke, November 1, 2001; 32(11): 2592 - 2596. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Hinkle A Descriptive Study of Function in Acute Motor Stroke West J Nurs Res, April 1, 2001; 23(3): 296 - 312. [Abstract] [PDF]
|
|
|
|
|
|
L. S. Williams, E. Y. Yilmaz, and A. M. Lopez-Yunez Retrospective Assessment of Initial Stroke Severity With the NIH Stroke Scale Stroke, April 1, 2000; 31(4): 858 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Briley, S. Haroon, S. M. Sergent, and S. Thomas Does leukoaraiosis predict morbidity and mortality? Neurology, January 11, 2000; 54(1): 90 - 90. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Tanaka, Tanaka, Sekka, Shinozaki, Hyodo, Umetani, and Mori Digitized Cerebral Synchrotron Radiation Angiography: Quantitative Evaluation of the Canine Circle of Willis and Its Large and Small AJNR Am. J. Neuroradiol., May 1, 1999; 20(5): 801 - 806. [Abstract] [Full Text]
|
|
|
|
 |
|
 M. Fisher and J. Bogousslavsky Further Evolution Toward Effective Therapy for Acute Ischemic Stroke JAMA, April 22, 1998; 279(16): 1298 - 1303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Chamorro, J. Pujol, A. Saiz, N. Vila, J. C. Vilanova, M. Alday, and R. Blanc Periventricular White Matter Lucencies in Patients With Lacunar Stroke: A Marker of Too High or Too Low Blood Pressure? Arch Neurol, October 1, 1997; 54(10): 1284 - 1288. [Abstract] [PDF]
|
|