An autopsy study of the incidence of lacunes in relation to age, hypertension, and arteriosclerosis.

Abstract

We investigated selected features of lacunes in 1,086 necropsy cases. Lacunes were found in brains from patients above the age of 40 years and were most common in brains from persons in their sixties but decreased in number in brains from older persons. The most common site of lacunes was the frontal lobe white matter, followed by the pntamen, pons, parietal lobe white matter, thalamus, and caudate nucleus in descending order of frequency. By dividing the 1,086 cases into three groups according to blood pressure, we found more lacunes in the hypertensive and borderline hypertensive groups than in the normotensive group; the average number of lacunes per brain in each group was 3.61, 2.77, and 1.15, respectively. Diastolic hypertension was more closely related to the number of lacunes than was systolic hypertension. The extent of arteriolosclerosis of the medullary arteries in the frontal lobe white matter was measured and compared with the number of lacunes. There was a close correlation between lacunes and arteriolosclerosis in all age groups. (Stroke 1991^2:993-996) A lacunar infarct is an ischemic lesion frequently observed in the basal ganglia, thalamus, brain stem, and cerebral white matter of elderly patients. The development of techniques such as computed tomography and magnetic resonance imaging has made it easier to locate lacunes, resulting in more clinical studies using these methods. [1][2][3][4][5][6] We investigated lacunes in 1,086 brains, both macroscopically and histologically, in an attempt to correlate lacunes, aging, hypertension, and arteriolosclerosis. Subjects and MethodsWe reviewed 1,086 brains that were necropsied from 1965 to 1988 and had been kept in formalin at Kurate Kyoritsu Hospital, a 300 -bed chronic-care institution with medical, geriatric, and neuropsychiatric wards. The age of the persons from whom the brains were obtained ranged from 19 to 98 years.We classified blood pressures retrospectively from clinical records as the mean of 10 separate readings. Hypertension was defined as a systolic pressure of 160 mm Hg or a diastolic pressure of S95 mm Hg. Received December 5, 1990; accepted April 16, 1991. Normotension was a systolic pressure of ^140 mm Hg together with a diastolic pressure of ^90 mm Hg. Those cases with blood pressures between the normotensive and hypertensive ranges were defined as having borderline hypertension. 7 Some patients had histories of definite hypertension prior to admission. Others were normotensive but took antihypertensive drugs and were therefore included in the hypertensive group. By definition, 429 cases were normotensive, 252 were borderline hypertensive, and 379 were hypertensive. The remaining 26 cases were unclassifiable because of inadequate blood pressure records (Table 1). Each brain was reexamined grossly as to atrophy of the cortex and the degree of atherosclerosis. The cerebral hemispheres were cut into coronal slices 5-10 mm thick, and the brain stem and cerebellum were cut into horizontal slices 2-4 mm thick. If necessary, thinner s...

Periventricular white matter lucency and cerebral blood flow autoregulation in hypertensive patients.

“…15 These pathogenetic features are similar to those seen in lacunar infarction. 16 Our patients had chronic hypertension and had experienced lacunar infarction or deep basal minor hemorrhage, suggesting the presence of hypertension-related arteriosclerosis. The present study did not include either physically disabled or demented patients, two common results of major stroke or multiple lacunar infarction.…”

Potential Animal Models of Lacunar Stroke

“…Few studies used older animals or ones with pre-existing vascular problems, although most patients with lacunar stroke are older and have vascular risk factors. 71 Few studies used appropriate neurological/behavioral tests to assess physiological/cognitive impairments. Clinical examination for "lacunar syndromes" 38 is the first assessment of a potential patient with human lacunar stroke.…”

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

“…269,270 Narrowing and sclerosis of small penetrating arteries in the subcortical regions of the brain are common findings on autopsy in chronic hypertension. [271][272][273][274] These changes are believed to contribute to hypoperfusion, loss of autoregulation, compromise of the blood-brain barrier, and ultimately to subcortical white matter demyelination, microinfarction, and cognitive decline. MRI studies in persons with chronic hypertension have revealed greater numbers of subcortical white matter lesions and microinfarcts, astrogliosis, ventricular enlargement, and extracellular fluid accumulation than in agematched controls.…”