Published online before print September 18, 2003, doi: 10.1161/01.STR.0000090351.41662.91
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(Stroke. 2003;34:2453.)
© 2003 American Heart Association, Inc.
Original Contributions |
Prospective Study of Single and Multiple Lacunar Infarcts Using Magnetic Resonance Imaging
Risk Factors, Recurrence, and Outcome in 175 Consecutive Cases
From the Stroke Clinic (A.A., L.M.), National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez," Tlalpan; Instituto Nacional de la Nutricion (C.C., J.H.), México City; and Hospital Ángeles de Querétaro (F.B.), México.
Correspondence to Antonio Arauz, MD, Instituto Nacional de Neurología, Insurgentes Sur 3877, Colonia La Fama, Tlalpan, México, DF, CP 14269. E-mail arauzg{at}prodigy.net.mx
Background and Purpose— We investigated whether lacunar infarct (LI) patients with >1 lacune have different vascular risk factors, a different prognosis, and poorer functional outcome than those with a single lacune.
Methods— The study included 175 first-ever LI patients. The group was divided according to the presence of multiple (n=136) or single (n=39) LI. The association of single or multiple LI with the principal vascular risk factors, leukoaraiosis, outcome, and recurrence was investigated with logistic regression models that included age, sex, and cardiac disease.
Results— No significant differences were found between single and multiple LI with respect to age, hypertension, hyperlipidemia, smoking, and heavy alcohol drinking. Diabetes mellitus (odds ratio [OR], 2.43; 95% CI, 1.09 to 5.4), high levels of hematocrit (>0.47) (OR, 1.09; 95% CI, 1.04 to 1.21), and leukoaraiosis (OR, 3.58; 95% CI, 1.77 to 7.51) were significantly related to multiple but not to single LI. Stroke recurrence rate was 7.7% in patients with single LI and 24.3% in the multiple LI group (OR, 3.84; 95% CI, 1.1 to 13.3). During a median follow-up of 12 months (range, 6 to 156 months), 94% of the single LI patients and 77.2% of the multiple LI patients had favorable outcomes (Rankin Scale score 0 to 2) (OR, 5.4; 95% CI, 1.25 to 23.9).
Conclusions— Diabetes mellitus, leukoaraiosis, and high levels of hematocrit are important risk factors in patients with >1 LI. The presence of multiple LI may be an important prognostic indicator not only for functional recovery but also for a higher rate of recurrence.
Key Words: diabetes mellitus • hypertension • lacunar infarction • leukoaraiosis
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