Clinical evaluation of 625 lacunar syndrome patients

Aim: Lacunar syndromes consist of a group of characteristic clinical presentations that are usually compatible with a small deep infarct. Validation of these syndromes could help neurologists predict the prognosis and type of cerebrovascular disease. Materials and Methods: Consecutive stroke patients on 2 Iranian stroke registries compiled between 2001 and 2007 were enrolled in this prospective validation study. Lacunar syndromes were defined as pure motor, pure sensory, mixed sensory motor, ataxic hemiparesis, dysarthria clumsy hand, and atypical subtypes. All of the patients with ischemic stroke had at least one brain CT scan performed 48 h after stroke. Patients whose CT scan showed a corresponding lacuna and patients with no visible new lacuna or other new lesion were assumed as appropriate to the lacunar infarction. Results: Lacunar syndrome was observed in 625 patients (286 female, 339 male; mean age: 68.05 ± 8.9 years), accounting for 21.3% of the patients on our stroke registry. Lacunar syndromes were detected with a sensitivity of 83.7%, specificity of 96.5%, PPV of 87.8%, and NPV of 95.4% (CI: 95%). Brain CTs of 546 patients (87.4%) were appropriate to lacunar infarct. All subtypes of lacunar syndrome had more than 97% specificity. Pure motor and mixed sensory motor syndromes were associated with a PPV of 82.9% and 81.5%, respectively. Pure sensory syndrome, ataxic hemiparesis, dysarthria clumsy hand, and atypical lacunar syndromes had a PPV of 96.6%, 97.5%, 100%, and 95.4%, respectively. Conclusions: Lacunar syndromes have moderate to high sensitivity and high specificity for the detection of lacunar brain infarction. Brain CTs in 12.6% of patients with lacunar syndrome did not correspond with lacunar stroke.

Anahtar Kelimeler:

Key words: Lacunar syndrome, sensitivity, specificity

Clinical evaluation of 625 lacunar syndrome patients

Keywords:

Key words: Lacunar syndrome, sensitivity, specificity,

PDF

___

Arboix A, Garcia-Plata C, Garcia-Eroles L, Massons J, Comes E, Oliveres M, Targa C. Clinical study of 99 patients with pure sensory stroke. J Neurol 2005; 252: 156-162.
Arboix A. Clinical study of 23 patients with ataxic hemiparesis. Med Clin 2004; 122: 342-344.
Arboix A, Bell Y, Garcia-Eroles L, Massons J, Comes E, Balcells M, Targa C. Clinical study of 35 patients with dysarthria-clumsy hand syndrome. J Neurol Neurosurg Psychiatry 2004; 75: 231- 234.
Adams HP, Bendixen BH, Kappelle LT, Biller J, Love BB, Gordon DL et al. Classification of stroke subtypes of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35-41. Arboix A, Lopez-Grau M, Casanovas C, Garcia-Eroles L, Massons J, Balcells M. Clinical study of 39 patients with atypical lacunar syndrome. J Neurol Neurosurg Psychiatry 2006; 77: 381-384.
Ghandehari K, Izadi Mood Z. Khorasan Stroke registry: Analysis of 1392 stroke patients. Arch Iranian Med 2007; 10: 327-334.
De Reuck J, Hemelsoet D, Nieuwenhuis L, Van Maele G. Computerized tomographic changes in lacunar syndromes. Clin Neurol Neurosurg 2005; 108: 18-24.
Vemmos KN, Takis CE, Georgilis K, Zakopoulos NA, Lekakis JP, Papamichael CM et al: The Athens Stroke Registry: results of a five-year hospital-based study. Cerebrovasc Dis 2000; 10: 133- 141.
Moulin T, Tatu L, Vuillier F, Berger E, Chavot D, Rumbach L et al: Role of stroke data bank in evaluating cerebral infarction subtypes: patterns and outcome of 1776 consecutive patients from the Besancon Stroke Registry. Cerebrovasc Dis 2000; 10: 261-271.
Lee BC, Hwang SH, Jung S, Yu KH, Lee JH, Cho SJ et al. The Hallym Stroke Registry: a web-based stroke data bank with an analysis of 1654 consecutive patients with acute stroke. Eur Neurol 2005; 54: 81-87.
Mead GE, Lewis SC, Wardlaw JM, Dennis MS, Warlow CP. How well does the Oxfordshire community stroke project classification predict the site and size of the infarct on brain imaging? J Neurol Neurosurg Psychiatry 2000; 68: 558-562.
Wodek A, Sarzynska-Dlugosz I, Sandercock PA, Czlonkowska A. Agreement between the clinical Oxfordshire Community Stroke Project classification and CT findings in Poland. Eur J Neurol 2004; 11: 91-96.
Lindgren A, Norrving B, Rudling O, Johansson BB. Comparison of clinical and neuroradiological findings in first-ever stroke: A population-based study. Stroke 1994; 25: 1371-1377.
Chamorro AM, Sacco RL, Mohr JP, Foulkes CS, Kase TK, Tatemichi PA et al. Lacunar infarction: Clinical-Computed Tomographic correlation in the Stroke Data Bank. Stroke 1991; 22: 175-181.
Arboix A, Malti-Vilalta JL. Lacunar syndromes not due to lacunar infarcts. Cerebrovasc Dis 1992; 2: 287-292.
Gan R, Sacco RL, Kargman JK, Roberts JK, Boden-Albala B, Gu Q. Testing the validity of the lacunar hypothesis: The Northern Manhattan Stroke Study experience. Neurology 1997; 48: 1204- 1211.
Bamford J, Sandercock P, Jones L, Warlow C. The natural history of lacunar infarction: The Oxfordshire Community Stroke Project. Stroke 1987; 18: 545-551.
Arboix A, Garcia-Eroles L, Massons J, Oliveres M, Targa C. Hemorrhagic lacunar stroke. Cerebrovasc Dis 2000; 10: 229- 234.
Phillips S, Dai D, Mitnitski A, Gubitz GJ, Gubitz GJ, Johnston KC, Koroshetz WJ et al. Clinical diagnosis of lacunar stroke in first 6 hours after symptom onset: Analysis of data from Glycine Antagonist In Neuroprotection (GAIN) Americas Trial. Stroke 2007; 38: 2706-2711.
Bamford JM. Classical lacunar syndromes. In: Bogousslavsky J, Caplan L editors, Stroke syndromes. second edition. Cambridge: Cambridge University Press; 2001. p. 583-588.
Blecic SA, Bogousslavsky J, Van Melle G, Regli F. Isolated sensorimotor stroke: a reevaluation of clinical topographic and etiological patterns. Cerebrovasc Dis 1993; 3: 357-363.
Kawano H, Yonemura K, Misumi Y, Hashimoto Y, Hirano T, Uchino M. Diagnostic validity of sensory motor stroke. Rinsho Shinkeigaku 2005; 45: 571-574. Warlow CP, Dennis MS, van Gijn J, Hankey GJ, Sandercock PAG, Bamford JM, Wardlaw JM. Stroke: A practical guide to management, 3rd ed. London: Blackwell Science 2004. p. 243- 244.