Lacunar syndromes due to small haemorrhagic lesions.

ABSTRACT

OBJECTIVE: To study the frequency, clinical presentations and prognostic aspects of haemorrhagic lacunar syndromes. MATERIAL AND METHODS: 375 patients of cerebrovascular accidents admitted in neurology wards over 2 years were studied. Based on CT findings, 114 patients were diagnosed as intra cerebral haemorrhage (ICH). They were assessed in detail by careful history and examination of neurological status. Coagulation studies, MRI and angiography were done in selected cases. RESULTS: In 17 (15%) patients, size of hematoma was < 2 cms as seen in CT scan. The sites of these small haemorrhages were in basal ganglia (6 patients), internal capsule (3 patients), thalamus (5 patients) and pons (3 patients). Depending on their location they presented as pure motor stroke, pure sensory stroke, ataxic hemiparesis, sensorimotor stroke and clumsy hand-dysarthia syndrome. Three patients showed interesting phenomena like transient ischemic attack caused by bleed or previous disease showing improvement after bleed. Prognosis of these small ICH was excellent with 100% survival rate and lesser disability as shown by good functional recovery. CONCLUSIONS: Haemorrhagic lacunar syndromes are not just the statistical curiosities but could have significant prognostic bearing.