Clinical evaluation of 625 lacunar syndrome patients

A lacuna is an area of infarction within the territory of a single perforated artery. Lacuna patients may present with numerous clinical syndromes. Lacunae typically present with highly focal brain symptoms (1). The clinical expression of lacunar infarcts is related to their location. Lacunae are more frequent in the basal ganglia, internal capsule, pons, and corona radiate (1); therefore, cortical manifestations, including aphasia, apraxia, agnosia, and neglect, are not seen in these patients (2,3). Homonymous hemianopsia and seizure are very rare in patients with lacunar syndrome (2,3). These types of manifestations are exclusionary criteria for the diagnosis of lacunar stroke (2,3). A decreased level of consciousness and headache are rarely caused by lacunar infarction (2,3). Any clinical pattern that has been convincingly linked to a pathological lacuna or a corresponding small deep infarct based on neuroimaging should be referred to as a lacunar syndrome (4). The advantage of recognizing these syndromes in clinical practice is the high probability of underlying lacunar infarcts (4). Although magnetic resonance imaging (MRI) is superior to computerized tomography (CT) in detecting lacunar brain infarctions (5), validation of lacunar syndromes based on MRI in a large number of patients is too expensive. Most recent validation studies on lacunar syndromes were based on brain CT scanning. The present validation study investigated the diagnostic value of lacunar syndromes in patients on our stroke registries.