The history, current situation and prospect of lacunar infarct / 中华神经科杂志

The modern concept of lacunar infarct is largely based on the meticulous postmortem work of Fisher from the 1950s to 1970s, which forms the basis of the"lacunar hypothesis". Along with the application of CT or MRI techniques and classification of ischemic stroke subtypes, the lacunar infarct was endowed with the profile of imaging diagnosis and stroke subtypes. Thus, the concept of lacunar infarct has far expanded the initial pathological meanings and the terminology and definitions for lacunar infarct vary widely. In this review, the historical pathological findings and the term evolution of lacunar infarct were systemically reviewed, with a focus toward future directions in the complex entity of lacunar infarct.

Thirteen-and-a-Half syndrome stroke: A case report

@#We describe a 52-year old woman who developed one- and-a-half syndrome with an ipsilateral trigeminal and facial nerve palsy from a lacunar infarct of the left paramedian pontine area likely involving the median-paramedian perforators of the basilar artery.

Perfil clínico diferencial entre los infartos lacunares y los infartos cerebrales aterotrombóticos / Differential clinical profile of lacunar infarcts compared to atherothrombotic brain infarcts

Aims and objectives: The present study makes a comparative analysis between the clinical profile of lacunar infarcts (LI) and that of atherothrombotic brain infarcts (ABI). Methods: Hospital-based descriptive study of 1809 consecutive patients admitted over a period of 24 years with a diagnosis of lacunar cerebral infarction (n = 864) or atherothrombotic cerebral infarction (n = 945). A comparative analysis of the demographic data, cerebral vascular risk factors, clinical data and hospital evolution between both subtypes of cerebral infarction was performed using a univariate and multivariate statistical methodology. Results: LI accounted for 26.5% and ABI for 28.9% of all cerebral infarctions in the registry. The variables directly and independently associated with ABI were: ischemic heart disease, previous transient ischemic attack, previous cerebral infarction, peripheral vascular disease, anticoagulant therapy, age > 85 years, vegetative symptoms, decreased level of consciousness, sensory deficit, visual deficit, speech disorders, and neurological, respiratory and urinary complications during hospital admission. In contrast, the absence of neurological symptoms at hospital discharge was directly associated with LI. Conclusions: LI and ABI have a distinct clinical profile. The best functional prognosis of LI during the acute phase of the disease is characteristic. In contrast, ICAs have a higher atherosclerotic burden and a worse prognosis.

Fundamentos y objetivo: El objetivo del estudio es efectuar un análisis comparativo entre el perfil clínico de los infartos lacunares (IL) y el perfil de los infartos cerebrales aterotrombóticos (ICA). Métodos: Estudio hospitalario descriptivo de 1809 pacientes consecutivos ingresados durante un período de 24 años con el diagnóstico de infarto cerebral de tipo lacunar (n = 864) o por infarto cerebral aterotrombótico (ICA) (n = 945). Se realizó un análisis comparativo de los datos demográficos, factores de riesgo vascular cerebral, datos clínicos y de evolución hospitalaria utilizando una metodología estadística univariada y, posteriormente, multivariada. Resultados: Los IL representaron el 26.5% y los ICA el 28.9% del total de infartos cerebrales del registro. Las variables asociadas directamente y de forma independiente con los ICA fueron: cardiopatía isquémica, ataque isquémico transitorio previo, infarto cerebral previo, enfermedad vascular periférica, uso de anticoagulantes, edad > 85 años, síntomas vegetativos, disminución del nivel de conciencia, déficit sensitivo, déficit visual, trastornos del habla y complicaciones neurológicas, respiratorias y urinarias durante el ingreso hospitalario. En cambio, la ausencia de sintomatología neurológica al alta se asoció directamente con los IL. Conclusiones: Los IL y los ICA tienen un perfil clínico diferenciado. Es característico el mejor pronóstico funcional de los IL durante la fase aguda de la enfermedad. En cambio, los ICA presentan mayor carga aterosclerótica y peor pronóstico evolutivo.

Evolving Concept of Small Vessel Disease through Advanced Brain Imaging / 대한뇌졸중학회지

Imaging plays a crucial role in studying and understanding cerebral small vessel disease. Several important findings have emerged from recent applications of advanced brain imaging methods. In patients with acute lacunar syndromes, diffusionweighted MRI studies have shown that the diagnostic precision of using clinical features alone or combined with CT scan findings to diagnose small vessel disease as the underlying cause is poor. Followup imaging studies on patients with acute infarcts related to small vessel disease have shown that the infarct may cavitate, merge into white matter disease abnormalities, or become invisible with time. High resolution MRI may demonstrate intracranial atherosclerosis in larger arteries (that may block orifices of penetrating arteries and cause small deep infarcts), but abnormalities in single penetrating arteries cannot as yet be consistently and reliably visualized for use in clinical practice. The epidemiology and risk factors of silent cerebral infarcts have been further delineated. Patterns of new incident silent infarcts appear related to existing white matter disease, suggesting similarities in pathophysiology. Silent deep infarcts causes local cortical atrophy, and can affect connectivity in the brain. Studies on cerebral microbleeds have shown consistent patterns in their effects on prognosis for a large number of outcomes, but the implications of cerebral microbleeds for treatment decisions remain to be established. Cortical microinfarcts represent the latest addition to the spectrum of small vessel disease in the brain, and appears as the most prevalent SVD entity. An important consensus document on neuroimaging standards for small vessel disease has been recently published.

Relationship of White-Matter Lesions and Lacunar Infarcts with Cardiovascular Risk Factors

BACKGROUND: Magnetic resonance imaging (MRI) findings of white-matter lesions are different from those of lacunar infarcts; however, both these conditions are related to cardiovascular risk factors. This study was performed to investigate the differences in the relationships of white-matter lesions and lacunar infarcts with cardiovascular risk factors and differences between the metabolic characteristics of patients with these conditions. METHODS: We included 4,255 patients who showed neurological deficits during health checkups. These individuals were classified into the following 3 groups on the basis of MRI findings: normal, white-matter lesion, and lacunar infarct. The groups were compared for age; weights; prevalence of metabolic syndrome; and levels of blood pressure, blood glucose, lipid, high sensitivity C-reactive protein, and HbA1c. RESULTS: Age, body mass index (BMI); waist circumference; levels of blood pressure, blood glucose, triglycerides and HbA1c; and prevalence of metabolic syndrome and its components were the highest in lacunar infarct group, followed by white matter lesion group, and normal group. Age and diastolic blood pressure level were related to white matter lesions, and age, systolic blood pressure level, and blood glucose level were related to lacunar infarcts. Further, the prevalence of the above-mentioned lesions increased with increase of the number of the components of metabolic syndrome. CONCLUSIONS: This study suggests that lacunar infarct is more advanced lesion than white matter lesion. Among all the cardiovascular risk factors, high blood pressure and impaired fasting blood glucose levels were significantly related to white-matter lesions and lacunar infarct.

Cognitive Function in Patients with First Lacunar Infarct / 中国康复理论与实践

@#Objective To evaluate the cognitive impairment and the related factors in patients after first lacunar infarct （LI）. Methods96 patients with LI and 40 controls were assessed with mini-mental state examination（MMSE）, digit span test （DST）, verbal fluency test （VFT）and clock drawing test （CDT）. ResultsThe scores of MMSE, DST, VFT and CDT were significantly lower in LI group than in control group (P＜0.05). Cognitive impairment occurred in 37 (38.5%) patients with LI after first stroke. The scores of MMSE, DST, VFT and CDT were lower in the patients with multiple infarcts than with single infarct (P＜0.05), and lower in patients with infarcts affecting the frontal lobe, thalamus and basal ganglia than affecting other area (P＜0.05). The scores of MMSE were lower in the patients with prior vascular risk factors than without risk factors (P＜0.05). ConclusionLacunar infarction usually leads to cognitive impairment. Cognitive function is associated with multiple infarcts, lesions affecting the frontal lobe, thalamus and basal ganglia and those with prior vascular risk factors.

Correlative factors of cognitive impairment in patients with lacunar infarcts / 西安交通大学学报·英文版

Objective: To study the relationships between cognitive impairment in patients with lacunar infarcts and quantitative CT measures and to determine the independent correlative factors of cognitive impairment. Methods: Neuropsychological examination was conducted for 128 patients with acute lacunar infarct. Number, location, and volume of infarcts, cerebral atrophy index and severity of white matter lesions (WMLs) were measured and recorded. Results: The number of lacunar infarcts in cognitive impairment (CI) group was significantly larger than that in cognitive normal (CN) group. Mean width of sulcus and sylvian fissure, index of frontal horn and ventricular-brain ratio (VBR) were significantly different in both groups. There were more patients with 3 grades or 4 grades WMLs in CI group (62%) than those in CN group (22%). The total volume of lacunar infarcts showed no statistically significant difference. Logistic regression analysis indicated that the number of lacunar infarcts in frontal subcortex and thalamus, the volume of infarcts in anterior periventricular white matter, width of cerebral sulcus and sylvian fissure were correlated with cognitive impairment respectively. Additionally, age and education were correlative factors of cognitive impairment in patients with lacunar infarct. Conclusion: Correlative factors of cognitive impairment in patients with lacunar infarct are not merely one feature, but a combination of infarct features (number, location, and volume), cortical atrophy and host factors (age and education).

Correlative factors of cognitive impairment in patients with lacunar infarcts / 药物分析学报

Objective To study the relationships between cognitive impairment in patients with lacunar infarcts and quantitative CT measures and to determine the independent correlative factors of cognitive impairment. Methods Neuropsychological examination was conducted for 128 patients with acute lacunar infarct. Number, location, and volume of infarcts, cerebral atrophy index and severity of white matter lesions (WMLs) were measured and recorded. Results The number of lacunar infarcts in cognitive impairment (CI) group was significantly larger than that in cognitive normal (CN) group. Mean width of sulcus and sylvian fissure, index of frontal horn and ventricular-brain ratio (VBR) were significantly different in both groups. There were more patients with 3 grades or 4 grades WMLs in CI group (62%) than those in CN group (22%). The total volume of lacunar infarcts showed no statistically significant difference. Logistic regression analysis indicated that the number of lacunar infarcts in frontal subcortex and thalamus, the volume of infarcts in anterior periventricular white matter, width of cerebral sulcus and sylvian fissure were correlated with cognitive impairment respectively. Additionally, age and education were correlative factors of cognitive impairment in patients with lacunar infarct. Conclusion Correlative factors of cognitive impairment in patients with lacunar infarct are not merely one feature, but a combination of infarct features (number, location, and volume), cortical atrophy and host factors (age and education).

Cerebrovascular, and Other Health Effects, Due to the Exposure of Ex-Workers to Carbon Disulfide in the Maunfacture of Rayon / 대한산업의학회지

OBJECTIVE: The purpose of this study was to evaluate the cerebrovascular and other related health effcets, due to the exposure of ex-workers to carbon disulfide in the manufacture of rayon. METHODS: The study subjects comprised of 453 workers from the rayon manufacturing industry (387 males, 66 females). They were examined with a brain MRI and for other risk factors related to their occupation, such as age, work department, work duration, duration of work cessation, and blood pressure. Laboratory tests were also performed such as blood sugar, hemoglobin, cholesterol, etc. The cumulative exposure levels were calculated as the mean exposure level, per work department, multiplied by the total work duration in months. RESULTS: 75.1% of the subjects were between the ages of 40 and 59 years. 76.0% of the subjects had worked in high exposure departments (e.g., department of spinning and refining etc). 52.5% of the subjects had worked for more than 10 years, and 63.3% of the subjects had ginven up the work (exposure) more than 10 years earlier. The brain MRI findings were normal, a single lacunar infarct, multiple lacunar infarcts (mostly, on subcortex and white matter), and a hemorrhage in 52.5, 8.6, 36.2 and 2.7% respectively. Multiple lacunar infarcts were not related to the cumulative exposure level but in the female workers only, were significantly related to the increasing level of work duration (p<0.05), and in the male workers only, were related to the increased duration of work cessation and age (p<0.01). Abnormal rates of laboratory tests were higher in the multiple lacunar infarcts subjects with hypertension compared to theose with normal brain MRI findings (p<0.01). CONCLUSIONS: The multiple lacunar infarcts of the brain seemed not to be related to the cumulative exposure level but to the low exposure departments, duration of work, duration of work cessation, age and hypertension. This was conducted as a health evaluation on workers from the rayon manufacturing industry who had terminated their exposure to carbon disulfide many years earlier.

Investigate of correlation between non-lacunar infarcts in the white matter of brain and intracranial or extracranial vessels stenosis / 临床神经病学杂志

Objective To investigate the correlation between non-lacunar infarcts in the white matter of brain and intracranial or extracranial vessels stenosis.Methods Brain magnetic resonance imaging(MRI) and digital subtraction angiography(DSA) were performed in 30 patients with non-lacunar infarcts in the white matter of brain and the results were analyzed.Results Of 12 cases with focal non-lacunar infarcts in the area of basal ganglion,9 cases were shown occlusion or highly stenosis of proximal segments of unilateral internal carotid artery(ICA) in DSA,2 cases were shown highly stenosis of M1 segment of middle cerebral artery(MCA),and 1 case was normal.Of 6 cases with focal non-lacunar infarcts in the area of basal ganglion and lateral periventricular white matter,3 cases were shown occlusion or highly stenosis of proximal segments of unilateral ICA in DSA,1 case was shown occlusion of C5 segment of unilateral ICA,and 2 cases were shown occlusion of M1 segments of MCA.Of 4 cases with focal non-lacunar infarcts in periventricular white matter or centrum ovale,1 case was shown occlusion of C5 segment of unilateral ICA,2 cases were shown highly stenosis of M1 segments of MCA,and the other one was normal.Of 8 cases with subcortical superior border infarction(SSBI) or subcortical lateral border infarction(SLBI),6 cases were shown occlusion or highly stenosis of proximal segments of unilateral ICA,1 case was shown occlusion of proximal segments of bilateral ICA,and 1 case was shown occlusion of M1 segment of MCA.Conclusion There are strong correlations between focal non-lacunar infarcts in the areas of basal ganglion or lateral periventricular white matter and the stenosis or occlusion of large arteries of ICA system.