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Stroke Survival by Subtype III
Focus on Lacunar Infarction
Data from a number of studies indicate
relatively high short- and long-term survival rates for patients
with lacunar stroke as compared with other stroke subtypes.
Lacunar infarction has been defined by Bamford et al as a
stroke associated with one of four recognized lacunar syndromes
in which CT or autopsy data are compatible with cerebral infarction
due to primary disease of a single perforating artery of the
brain. [Bamford J, et al. Stroke. 1987;18:545]. The
four recognized syndromes included pure motor stroke, pure
sensory stroke, pure sensory stroke, sensorimotor stroke,
and ataxic hemiparesis. In some studies, miscellaneous
other syndromes are included in the definition [Brainin
M, et al. Neuroepidemiology. 1992;11:190. Clavier I,
et al. Stroke. 1994;25:2005].
Although there is general agreement
that patients with lacunar infarction are more likely to survive
their stroke than those with other stroke subtypes, the reported
incidence of functional dependence among survivors varies
from one study to another. In an Oxfordshire Community
Stroke Project (OCSP) series of 515 first-ever strokes, of
which 102 were classified as lacunar infarction, it was found
that before the occurrence of lacunar infarction, approximately
80% of the patients were capable of independent existence
(the scale was not described), compared with 67% of patients
surviving at least 1 month and 66% of those surviving at
least 1 year [Bamford J, et al. Stroke. 1987;18:545].
Thus, approximately one-third of survivors were dependent
to some extent on other persons at 1 year; the investigators
noted that this is a proportion similar to survivors of other
types of stroke in the OCSP experience and emphasized that
lacunar infarcts occur in "strategically important areas."
In a study from France, 74% of
178 patients with a diagnosis of lacunar infarction had mild
or no disability at 1 year or more based on the Barthel Index
[Clavier I, et al. Stroke. 1994;25:2005]; this is consistent
with a study by Arboix et al, which reported mild or no neurologic
disability in approximately 78% of 227 patients with lacunar
infarcts [Arboix A, et al. Stroke. 1990;21:842]. Eight
percent of patients in the Clavier et al study required minor
help in their daily lives (Barthel Index < 95), and 18%
needed considerable help (Barthel Index < 85). The
main independent predictors of disability were age, diabetes,
history of stroke or transient ischemic attack, and type of
lacunar syndrome. In the latter regard, patients with
motor deficits (i.e., sensorimotor strokes, pure motor hemiparesis)
had the worst functional prognosis, whereas patient ataxic
hemiparesis or other lacunar syndromes recovered almost completely;
similar findings were previously reported by Gandolfo et al
[Gandolfo C, et al. Acta Neurol Scand. 1986;74:224].
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Stroke Education
