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(Stroke. 2006;37:1828.)
© 2006 American Heart Association, Inc.

Original Contributions

Large Subcortical Infarcts

Clinical Features, Risk Factors, and Long-Term Prognosis Compared With Cortical and Small Deep Infarcts

Patricia H.A. Halkes, MD; L. Jaap Kappelle, MD; Jan van Gijn, MD, FRCP, FRCPE; Iris van Wijk, MD; Peter J. Koudstaal, MD Ale Algra, MD

From the Department of Neurology, Rudolf Magnus Institute (P.H.A.H., J.v.G., L.J.K., I.v.W., A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, Netherlands; Rehabilitation Centre De Hoogstraat (I.v.W.), Utrecht, Netherlands; and Department of Neurology (P.J.K.), Erasmus Medical Center Rotterdam, Rotterdam, Netherlands.

Correspondence to Patricia H.A. Halkes, MD, University Hospital, Room H02.128, PO Box 85500, 3508 GA Utrecht, Netherlands. E-mail phalkes{at}umcutrecht.nl

Background and Purpose— In this study we compared risk factors, clinical features, and stroke recurrence in a large series of patients with large subcortical, cortical, or small deep infarcts.

Methods— Patients with a transient or minor ischemic attack (modified Rankin Scale grade of 3) who had a single relevant supratentorial infarct of presumed noncardioembolic origin on CT were classified as suffering from a large subcortical (n=120), small deep (n=324), or cortical (n=211) infarct. Mean follow-up was 8 years. Rates of recurrent stroke were compared with Cox regression.

Results— The clinical deficits caused by large subcortical infarcts resembled either those of a cortical or those of a small deep infarct. Risk factor profiles were similar in the 3 groups. The rate of recurrent stroke in patients with a large subcortical infarct (25/120; 21%) did not differ from that of patients with a cortical infarct (46/211; 22%) or with a small deep infarct (60/324; 19%). After adjustment for age, sex, and vascular risk factors, hazard ratios for recurrent stroke of large subcortical and cortical infarcts were 1.05 (95% CI, 0.65 to 1.70) and 1.17 (95% CI, 0.79 to 1.73), respectively, compared with small deep infarcts.

Conclusions— Clinical features, risk factor profiles, and stroke recurrence rate in patients with a large subcortical infarct only differ slightly from those in patients with small deep or cortical infarcts.

Key Words: classification • epidemiology • stroke, ischemic