Symptoms and probabilistic anatomical mapping of lacunar infarcts
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(2020) 2:21
Neurological Research and Practice
RESEARCH ARTICLE
Open Access
Symptoms and probabilistic anatomical mapping of lacunar infarcts Ewgenia Barow1*, Hans Pinnschmidt2, Florent Boutitie3, Alina Königsberg1, Martin Ebinger4,5, Matthias Endres5,6, Jochen B. Fiebach5, Jens Fiehler7, Vincent Thijs8,9, Robin Lemmens10,11,12, Keith W. Muir13, Norbert Nighoghossian14, Salvador Pedraza15, Claus Z. Simonsen16, Christian Gerloff1, Götz Thomalla1, Bastian Cheng1 and on behalf of the WAKE-UP investigators
Abstract Background: The anatomical distribution of acute lacunar infarcts has mainly been studied for supratentorial lesions. In addition, little is known about the association with distinct stroke symptoms, not summarized as classical lacunar syndromes. We aimed to describe the spatial lesion distribution of acute supra- and infratentorial lacunar infarcts and their association with stroke symptoms in patients eligible for thrombolysis. Methods: All patients enrolled in the WAKE-UP trial (efficacy and safety of magnetic resonance imaging [MRI]-based thrombolysis in wake-up stroke) were screened for lacunar infarcts on diffusion-weighted imaging (DWI). The relationship between the anatomical distribution of supra- and infratentorial lacunar infarcts, their demographic characteristics and acute stroke symptoms, defined by the National Institutes of Health Stroke Scale (NIHSS) score, were correlated and compared. Results: Maps of lesion distribution from 224 lacunar infarct patients (76 [33.9%] females, mean age [standard deviation] of 63.4 [11.5] years) were generated using computational image mapping methods. Median infarct volume was 0.73 ml (interquartile range [IQR] 0.37–1.15 ml). Median NIHSS sum score on hospital arrival was 4 (IQR 3–6). 165 (73.7%) patients had lacunar infarcts in the supratentorial deep white or grey matter, while 59 (26.3%) patients had infratentorial lacunar infarcts. Patients with supratentorial lacunar infarcts presented with a significantly lower occurrence of deficits in the NIHSS items gaze (p < 0.001) and dysarthria (p = 0.008), but had more often a paresis of the left arm (p = 0.009) and left leg (p = 0.068) compared to patients with infratentorial infarcts. Conclusions: The anatomical lesion distribution of lacunar infarcts reveals a distinct pattern and supports an association of localization with different stroke symptoms. Trial registration: NCT01525290. Keywords: Lacunar infarct, Magnetic resonance imaging, Lesion distribution, Probabilistic atlas, WAKE-UP
* Correspondence: [email protected] 1 Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original a
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