Lacunar infarction

Prognosis and complications
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By Catalina Ionita MD

Lacunes have some of the lowest mortality and recurrence rates as well as the best recovery and functional outcome of all strokes. A population-based study involving 442 patients showed that mortality rate in lacunar stroke increases from 1.4% in the first 30 days to 7% at 1 year and reaches 35% at 5-year follow-up (in comparison, cardioembolic stroke has a mortality rate of 30% during the first 30 days and reaches 80.4% after 5 years). The recurrence rate of lacunes increases from 1.4% in the first month to 7% at 1 year and 25% after 5 years, whereas in atherothrombotic stroke the recurrence rate is 18.5% in the first month and goes as high as 40% after 5 years (Petty 2000). A more recent Swedish study showed a mortality rate for lacunar infarction of 10.6% in the first year, 38% after 5 years, and 62% after 10 years. Although in the first year the recurrence rate for lacunar infarctions is lower than in nonlacunar strokes, from the second year it becomes similar to the recurrence of other stroke subtypes (Sacco 2006). A 10-year follow-up showed a 46.8% recurrence for lacunar infarctions versus a 46.5% recurrence for cardioembolic strokes (Eriksson 2001). More than 80% of patients with lacunar infarction have minimal or no disability after stroke. A good premorbid functional status and lacunar stroke subtype are predictors for a good outcome (Petty 2000; Hassaballa 2001), whereas the severity of motor deficit is highly predictive of a poor outcome (Samuelsson 1996). Some authors consider that leukoaraiosis and nondipping nocturnal hypertension are independent predictors for subsequent dementia, whereas diabetes, multiple lacunes, and high 24 hour-systolic hypertension are independent predictors for recurrent strokes (Yamamoto 2002). Symptomatic lacunes accompanied by multiple silent lacunes, hypertension, and arteriolosclerosis confer a much poorer prognosis than solitary symptomatic lesions associated with microatheroma (de Jong 2002).

In This Article

Historical note and nomenclature
Clinical manifestations
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited