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Lacunar Stroke (lacunar + stroke)

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Medical Sciences	100%

Selected Abstracts

Acute ischemic stroke and transient ischemic attack in the very old , risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 years

EUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2007
J. I. Rojas
Old age groups have different risk profile and stroke features compared to younger groups. Our aim was to examine the risk factor profile and stroke subtype in patients older than 80 years with ischemic stroke. Data of 535 patients with ischemic stroke or transient ischemic attack (TIA) were prospectively recorded. Cardiovascular risk factors and stroke subtype in individuals aged 80 years or older were compared with patients under 80. Of 535 patients a total of 179 were over 80 years (33.5%). The mean age was 84.4 ± 4.4 years (61.8%; 111 women). The most common risk factors included hypertension (82.7%) and hyperlipidemia (40.2%). Lacunar stroke was the most frequent subtype of stroke (41.7%). When the groups were compared, we observed the following risk factors more frequently in the group older than 80: female patients (P = <0.001), hypertension (OR = 1.62), atrial fibrillation (OR = 2.64); whereas diabetes (OR = 0.54), hyperlipidemia (OR = 0.57), smoking (OR = 0.17) and obesity (OR = 0.58) were more frequent in the group younger than 80. In the old group we found a high incidence of ischemic stroke in women. We also found a higher frequency of hypertension and atrial fibrillation. The available and future epidemiological data will provide a better knowledge about the effect of typical risk factors in old people. [source]

Lacunar stroke is associated with diffuse blood,brain barrier dysfunction,

ANNALS OF NEUROLOGY, Issue 2 2009
FMedSci, Joanna M. Wardlaw MD
Objective Lacunar stroke is common (25% of ischemic strokes) and mostly because of an intrinsic cerebral microvascular disease of unknown cause. Although considered primarily to be an ischemic process, the vessel and tissue damage could also be explained by dysfunctional endothelium or blood,brain barrier (BBB) leak, not just ischemia. We tested for subtle generalized BBB leakiness in patients with lacunar stroke and control patients with cortical ischemic stroke. Methods We recruited patients with lacunar and mild cortical stroke. We assessed BBB leak in gray matter, white matter, and cerebrospinal fluid, at least 1 month after stroke, using magnetic resonance imaging before and after intravenous gadolinium. We measured tissue enhancement for 30 minutes after intravenous gadolinium by two image analysis approaches (regions of interest and tissue segmentation). We compared the enhancement (leak) between lacunar and cortical patients, and associations with key variables, using general linear modeling. Results We recruited 51 lacunar and 46 cortical stroke patients. Signal enhancement after gadolinium was higher in lacunar than cortical stroke patients in white matter (p < 0.001) and cerebrospinal fluid (p < 0.003) by both analysis methods, independent of other variables. Signal enhancement after gadolinium was also associated with increasing age and enlarged perivascular spaces, but these did not explain the lacunar-cortical difference. Interpretation Patients with lacunar stroke have subtle, diffuse BBB dysfunction in white matter. Further studies are required to determine the relative contributions of BBB dysfunction and/or ischemia to the microvascular and brain abnormalities in lacunar stroke. Ann Neurol 2009;65:194,202 [source]

Symptomatic restless leg syndrome after lacunar stroke: A lesion study

MOVEMENT DISORDERS, Issue 11 2006
Alexander Unrath MD
[source]

Reduced N -acetylaspartate is consistent with axonal dysfunction in cerebral small vessel disease

NMR IN BIOMEDICINE, Issue 3 2009
Arani Nitkunan
Abstract Background: Cerebral small vessel disease (SVD) is an important cause of cognitive impairment, but the pathophysiological mechanisms remain unclear. We used 1H MRS to investigate brain metabolic differences between patients with SVD and controls and correlated this with cognition. Methods: 35 patients with SVD (lacunar stroke and radiological evidence of confluent leukoaraiosis) and 35 controls underwent multi-voxel spectroscopic imaging of white matter to obtain absolute metabolite concentrations of N -acetylaspartate (NAA), total creatines, total cholines, myo -inositol, and lactate. A range of cognitive tests was performed on patients with SVD, and composite scores were calculated. Results: Scans of sufficient quality for data analysis were available in 29 cases and 35 controls. NAA was significantly reduced in patients compared with controls (lower by 7.27%, P,=,0.004). However, when lesion load within each individual voxel (mean 22% in SVD vs 5% in controls, P,<,0.001) was added as a covariate, these differences were no longer significant, suggesting that the metabolite differences arose primarily from differences in lesioned tissue. In patients with SVD, there was no correlation between cognitive scores and any brain metabolite. No lactate, an indicator of anaerobic metabolism, was detected. Conclusions: The most consistent change in SVD is a reduction in NAA, a marker of neuronal integrity. The lack of correlation with cognition does not support the use of MRS as a surrogate disease marker. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Retinal fractals and acute lacunar stroke

ANNALS OF NEUROLOGY, Issue 1 2010
Ning Cheung MBBS
This study aimed to determine whether retinal fractal dimension, a quantitative measure of microvascular branching complexity and density, is associated with lacunar stroke. A total of 392 patients presenting with acute ischemic stroke had retinal fractal dimension measured from digital photographs, and lacunar infarct ascertained from brain imaging. After adjusting for age, gender, and vascular risk factors, higher retinal fractal dimension (highest vs lowest quartile and per standard deviation increase) was independently and positively associated with lacunar stroke (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.49,12.17 and OR, 1.85; 95% CI, 1.20,2.84, respectively). Increased retinal microvascular complexity and density is associated with lacunar stroke. ANN NEUROL 2010;68:107,111 [source]

Lacunar stroke is associated with diffuse blood,brain barrier dysfunction,

Imaging appearance of the symptomatic perforating artery in patients with lacunar infarction: Occlusion or other vascular pathology?

ANNALS OF NEUROLOGY, Issue 2 2001
Joanna M. Wardlaw FRCR
Lacunar infarction is associated with distinct clinical features. It is thought to result from occlusion of a deep perforating artery in the basal ganglia, centrum semiovale, or brainstem. However, occluded perforating arteries have only rarely been observed at postmortem in patients with lacunar stroke and have not been noted previously on imaging despite the increasing sophistication of the techniques. We observed nine patients with lacunar stroke imaged with computed tomography and magnetic resonance imaging in whom we observed a linear structure with density or signal features consistent with an occluded (or at least abnormal) perforating artery associated with the relevant lacunar infarct. The appearance might also have been caused by a leak of blood and fluid into the perivascular space around the artery, as in several patients the width of the tubular vessel-like structure (>1mm in diameter) was greater than the expected width of a perforating artery (<0.8mm in diameter). This interpretation is supported by the fact that the area of infarction was usually around the abnormal vessel, not at the end of it. We describe the patients' clinical and imaging features, and discuss alternative explanations for the imaging appearance and the implications for gaining insights into the cause of lacunar infarction. [source]

Prediction of length of stay for stroke patients

ACTA NEUROLOGICA SCANDINAVICA, Issue 1 2007
P. Appelros
Objectives ,, To examine the factors that influence acute and total length of stay (LOS) for stroke patients. Materials and methods ,, The basis of this investigation was a population-based cohort of first-ever stroke patients (n = 388). Subjects were survivors of the initial hospitalization (n = 295). Age, sex, social factors, risk factors, dementia, stroke type, and stroke severity, measured with the NIH stroke scale (NIHSS), were registered. Results ,, Mean acute LOS was 12 days and mean total LOS was 29 days. Independent predictors of acute LOS were stroke severity, lacunar stroke, prestroke dementia, and smoking. Independent predictors of total LOS were stroke severity and prestroke activities of daily living (ADL) dependency. The NIHSS items that best correlated with LOS were paresis, unilateral neglect and level of consciousness. Conclusions ,, Stroke severity is a strong and reliable predictor of LOS. The results of this study can be used as a baseline for evaluating cost-effectiveness of stroke care changes, e.g. organizational changes or evaluation of new drugs. [source]

Strokes in paroxysmal atrial fibrillation have more favorable outcome than in permanent atrial fibrillation

ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2009
J. Staszewski
Background,,, Permanent (ptAF) and paroxysmal (pxAF) atrial fibrillation carry similar risk of ischemic stroke (IS). Objective,,, Our aim was to compare the course of IS due to ptAF and pxAF. Methods,,, A prospective, single-center study was conducted in patients with AF and acute IS with 6-month follow-up. Results,,, We included 178 patients: 70 (39%) with pxAF and 108 (61%) with ptAF. Compared with patients with ptAF, patients with pxAF more often presented with subcortical, mainly lacunar strokes (21% vs 8%, P = 0.01) and were less frequently dependent at discharge (16% vs 42%, P < 0.001) and after 6 months (16% vs 20%, P < 0.001). Strokes in patients with pxAF were more frequently categorized as non-cardioembolic (35% vs 18%, P = 0.01). In the multivariate analysis, after adjustment for confounding factors (diabetes, chronic heart failure, high risk of thromboembolism and lack of prestroke anticoagulation), ptAF was an important risk factor for unfavorable short-term (OR 5.4; P < 0.01) and long-term outcomes (OR 2.6, P = 0.01) of IS. In all patients with AF, the occurrence of non-cardioembolic stroke was related to a reduced risk of dependence or death in short-term outcome (OR 0.4, P = 0.04) and marginally influenced long-term outcome (OR 0.49, P = 0.09). Conclusions,,, The present study suggests that, compared with patients with ptAF, ISs in patients with pxAF have better outcomes. [source]

Psychiatric disturbances in CADASIL: a brief review

ACTA NEUROLOGICA SCANDINAVICA, Issue 5 2008
R. Valenti
Background,,, Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease, clinically characterized by a variable combination of migraine, recurrent transient ischemic attack (TIA) or lacunar strokes, cognitive decline, and mood disturbances. However, the assessment of psychiatric disturbances in this disease has never been carried out systematically. Methods,,, This paper presents a brief review of the literature regarding the occurrence of psychiatric disorders in CADASIL patients. Results,,, The prevalence of psychiatric disorders in CADASIL patients is reported to range from 20% to 41%. The psychiatric disturbances reported with the highest frequency are mood disturbances (9,41%). Pooling together the studies and considering a total of 454 CADASIL patients reported in the literature, 106 of these were affected by mood disturbances (24%). The majority of studies however did not use any defined criteria to assess the presence of psychiatric disorders and diagnoses were mainly based on history or review of clinical records. Conclusions,,, The review of CADASIL literature suggests the need for a more structured approach to the investigation of these disturbances that are highly prevalent and may greatly impact quality of life in these patients. [source]