Blood pressure does no predict lacunar infarction.

Abstract

SUMMARY We studied the relation between blood pressure and type of cerebral infarction (large or lacunar) in 134 patients with acute hemispheral infarcts that were detectable by computed tomography and that could not be attributed to causes other than atherothrombotic arterial disease. Lacunae were present in 26 patients, and systolic blood pressures were higher in this group than in the 108 patients with large infarcts. The overlap was so wide, however, that large infarcts predominated at every level of blood pressure. The presence of a lacune can be inferred only from the combination of clinical signs and, most important, computed tomography. For the past few years we had adopted this policy in our department, although epidemiological studies indicate that hypertension is common in all types of stroke.7 Since the advent of computed tomography (CT) we have found not only large cortical infarcts in patients with severe hypertension, but we have also been surprised to find lacunar infarcts in some normotensive patients. This experience has been confirmed from several centres.8 9We have been prompted by these inconsistencies to review the blood pressure readings in a large series of patients with acute brain infarcts due to arterial disease.

Ischemic Lacunar Stroke in Patients With and Without Potential Mechanism Other Than Small-Artery Disease

“…This weak statistical significance is in accordance with the results of previous studies that failed to show a higher prevalence of hypertension in SAD lacunar compared with other types of ischemic stroke. [11][12][13][14][15][16]18 Asymptomatic stenoses of intracranial cerebral arteries were significantly more frequent in non-SAD than SAD lacunar strokes. Furthermore, 6 asymptomatic stenoses of the intracranial cerebral arteries were associated with lacunar infarcts in the territory of the corresponding perforating arteries, suggesting a causal relationship.…”

“…Subsequent clinical studies, including a community-based survey, generally failed to demonstrate significant differences in blood pressure or prevalence of hypertension between patients with lacunar strokes due to SAD or other causes. [11][12][13][14][15][16] Moreover, the suggested relationship between cerebral atherosclerosis and lacunar stroke was not See Editorial Comment, page 658 confirmed, and embolism was assumed to be a rare cause of lacunar stroke. 14,15,[17][18][19][20][21][22] Finally, it has not been investigated whether the larger size of lacunar infarcts that are potentially not caused by SAD is associated with more severe neurological deficits and a higher detection rate on brain imaging compared with lacunar strokes caused by SAD.…”

Prospective Study of Single and Multiple Lacunar Infarcts Using Magnetic Resonance Imaging

“…17,18,22 Despite these findings, the role of hypertension in LI has been questioned, mainly because other causal factors for LI such as embolus of cardiac or carotid origin have been found recently. 3,4,6,7,9,16,23,24 Kappelle and van Gijn 7 revised 14 LI studies and found that 43% to 83% of the patients were hypertensive. In a study of isolated systolic hypertension, Davis et al 25 found that diabetes mellitus and smoking are particularly associated with LI.…”

Carotid angiography in patients with lacunar infarction. A prospective study.

“…Furthermore, hypertension is common in patients with all types of ischemic strokes and does not necessarily predict strokes of the lacunar type. 3 At the same time, normal blood pressure and the absence of hypertensive retinal vasculopathy are not always associated with a normal ICA bifurcation (Table 2). Apparently some additional, as yet unknown, factor determines whether hypertension will affect small or large arteries.…”