Vascular Risk Factors Linked to Multiple Lacunar Infarcts

Abstract

Background: The pathogenesis of lacunar infarcts is still incompletely established. Data from the literature suggest that vascular risk factors differ among patients with multiple (MLI) and single lacunar infarcts (SLI). We reexamined this hypothesis using stricter inclusion criteria and a less selected study population. Methods: We evaluated 136 patients consecutively admitted for first-ever minor stroke to a general hospital with the characteristics of a community hospital. Vascular risk factors were studied by univariate and multivariate statistical analyses among the following subgroups of patients, classified according to CT findings: (a) with lacunar infarct; (b) with nonlacunar infarct (NLI); (c) with SLI; (d) with MLI; (e) with single, either lacunar or nonlacunar, infarct. Results: No significant difference was observed between patients with lacunar infarcts and patients with NLI. Compared to patients with SLI or NLI, patients with MLI had significantly more often a family history of hypertension, cardiomegaly on the chest radiograph and CT leukoaraiosis as well as a higher systolic and diastolic blood pressure on admission. Logistic regression analysis selected CT leukoaraiosis, Rx cardiomegaly and admission diastolic blood pressure as independent, significant predictors of MLI. Conclusion: In patients with first-ever minor stroke, the risk factor profile differs according to the evidence of SLI or MLI on the CT scan. In terms of risk factors, patients with SLI seem more similar to those with NLI than those with MLI. Based on the predicting effect of variables linked with type and severity of arterial hypertension, the CT appearance of MLI might express a more univocal and specific cerebrovascular pathology (hypertensive arteriolosclerosis).

Risk Factors for Lacunar Infarcts

“…For Lodder and Boiten [3], the established risk factors for lacunar infarcts are age, sex, hypertension, diabetes mellitus, ischemic heart disease, TIA, and current cigarette smoking. In our study, the frequencies of these risk factors are very similar to data collected in previous studies [3, 11]. …”

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

“…21 Clinical or morphological evidence of hypertension was found in 97% of the cases in the same study of Fisher and in Ͼ70% in other series. 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.…”

Leukoaraiosis

“…Lipohyalinosis, microatheroma, and, to a lesser extent, microembolism are considered the main causes of LI. At the occurrence of the first clinical lacunar stroke event, it has been observed 19,20 that when multiple (silent) lacunes are seen on imaging, both arterial hypertension and LA are more frequent than when a single (the only symptomatic) lacunar lesion is identified, suggesting that lipohyalinosis in the former case and microatheroma in the latter case might be selectively involved. In a longitudinal observation of 333 patients with a first-ever lacunar stroke, 21 mortality was Ͼ1.5-fold higher (odds ratio [OR], 1.74; 95% CI, 1.01 to 3.01) and the stroke recurrence rate was 2-fold higher (OR, 2.09; 95% CI, 1.08 to 4.06) among the 104 patients with multiple silent lesions than among the 229 patients with a single lesion.…”