Abstract
BACKGROUND: Acute lacunar ischaemic stroke, white matter hyperintensities, and lacunes are all features of cerebral small vessel disease. It is unclear why some small vessel disease lesions present with acute stroke symptoms, whereas others typically do not. AIM: To test if lesion location could be one reason why some small vessel disease lesions present with acute stroke, whereas others accumulate covertly. METHODS: We identified prospectively patients who presented with acute lacunar stroke symptoms with a recent small subcortical infarct confirmed on magnetic resonance diffusion imaging. We compared the distribution of the acute infarcts with that of white matter hyperintensity and lacunes using computational image mapping methods. RESULTS: In 188 patients, mean age 67 +/- standard deviation 12 years, the lesions that presented with acute lacunar ischaemic stroke were located in or near the main motor and sensory tracts in (descending order): posterior limb of the internal capsule (probability density 0.2/mm(3)), centrum semiovale (probability density = 0.15/mm(3)), medial lentiform nucleus/lateral thalamus (probability density = 0.09/mm(3)), and pons (probability density = 0.02/mm(3)). Most lacunes were in the lentiform nucleus (probability density = 0.01-0.04/mm(3) ) or external capsule (probability density = 0.05/mm(3)). Most white matter hyperintensities were in centrum semiovale (except for the area affected by the acute symptomatic infarcts), external capsules, basal ganglia, and brainstem, with little overlap with the acute symptomatic infarcts (analysis of variance, P <0.01). CONCLUSIONS: Lesions that present with acute lacunar ischaemic stroke symptoms may be more likely noticed by the patient through affecting the main motor and sensory tracts, whereas white matter hyperintensity and asymptomatic lacunes mainly affect other areas. Brain location could at least partly explain the symptomatic vs. covert development of small vessel disease.
| Original language | English |
|---|---|
| Pages (from-to) | 1044-1050 |
| Number of pages | 7 |
| Journal | International Journal of Stroke |
| Volume | 10 |
| Issue number | 7 |
| Early online date | 29 Jun 2015 |
| DOIs | |
| Publication status | Published - Oct 2015 |
Bibliographical note
Valdes Hernandez, Maria del C Maconick, Lucy C Munoz Maniega, Susana Wang, Xin Wiseman, Stewart Armitage, Paul A Doubal, Fergus N Makin, Stephen Sudlow, Cathie L M Dennis, Martin S Deary, Ian J Bastin, Mark Wardlaw, Joanna M eng 075611/Wellcome Trust/United Kingdom G1001245/Medical Research Council/United Kingdom MR/K026992/1/Medical Research Council/United Kingdom G0701120/Medical Research Council/United Kingdom 063668/Wellcome Trust/United Kingdom WT088134/Z/09/A/Wellcome Trust/United Kingdom 217NTU R37933/Chief Scientist Office/United Kingdom Research Support, Non-U.S. Gov't 2015/06/30 06:00 Int J Stroke. 2015 Oct;10(7):1044-50. doi: 10.1111/ijs.12558. Epub 2015 Jun 29.Keywords
- Aged Aged, 80 and over Analysis of Variance Brain/*pathology Cerebral Infarction/*pathology Cerebral Small Vessel Diseases/*pathology/*physiopathology Female Humans Image Processing, Computer-Assisted Magnetic Resonance Imaging Male Middle Aged Retrospective Studies Stroke/pathology acute lacunar infarct lacunar stroke lacunes small vessel disease stroke white matter hyperintensities