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Clinical study of 39 patients with atypical lacunar syndrome
  1. A Arboix1,
  2. M López-Grau2,
  3. C Casasnovas1,
  4. L García-Eroles3,
  5. J Massons1,
  6. M Balcells1
  1. 1Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Viladomat 288, E-08029 Barcelona, Spain
  2. 2Department of Internal Medicine, Hospital Universitari del Sagrat Cor, Barcelona, Spain
  3. 3Clinical Information Systems, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
  1. Correspondence to:
 Dr A Arboix
 Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Viladomat 288, E-08029 Barcelona, Spain; aarboix{at}hscor.com

Abstract

The aim of this study was to describe the clinical characteristics of atypical lacunar syndrome (ALS) based on data collected from a prospective acute stroke registry. In total, 2500 acute stroke patients were included in a hospital based prospective stroke registry over a 12 year period, of whom 39 were identified as having ALS and radiologically proven (by computed tomography or magnetic resonance imaging) lacunes. ALS accounted for 1.8% of all acute stroke patients, 2.1% of acute ischaemic stroke, and 6.8% of lacunar syndromes. ALS included dysarthria facial paresis (n = 12) or isolate dysarthria (n = 9), isolated hemiataxia (n = 4), pure motor hemiparesis with transient internuclear ophthalmoplegia (n = 4), pure motor hemiparesis with transient subcortical aphasia (n = 3), unilateral (n = 2) or bilateral (n = 3) paramedian thalamic infarct syndrome, and hemichorea hemiballismus (n = 2). Atypical lacunar syndromes were due to small vessel disease in 96% of patients. Atherothrombotic infarction occurred in one patient and cardioembolic infarct in another, both presenting pure dysarthria. Outcome was good (in hospital mortality 0%, symptom free at discharge 28.2%). After multivariate analysis, the variables of speech disturbances, nausea/vomiting, ischaemic heart disease, and sensory symptoms were found to be significantly associated with ALS. In conclusion, atypical lacunar syndrome is an infrequent stroke subtype (one of each 14 lacunar strokes). ALS occurred in 6.8% of lacunar strokes. Isolated dysarthria or dysarthria facial paresis were the most frequent presenting forms. The prognosis of this infrequent non-classic lacunar syndrome is good.

  • ALS, atypical lacunar syndromes
  • atypical lacunar syndrome
  • ischaemic stroke
  • isolated dysarthria
  • lacunar infarct
  • risk factors

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Footnotes

  • Competing interests: none

  • The institutional review board approved the use of data collected in the hospital-based stroke registry

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