To evaluate the prevalence of lacunar syndromes due to non ischaemic causes 97 consecutive patients with recent (less than 72 hours) onset of a recognised lacunar syndrome were studied. Investigations showed that nine cases were due to non ischaemic pathologies (four primary intracerebral haemorrhages, one rupture of a mycotic aneurysm, one cerebral abscess, one subdural haematoma, one glioblastoma, one multiple sclerosis). Clinical features did not allow a separation of non ischaemic from ischaemic patients; however, hypertension was significantly more frequent in the latter group, and its positive predictive value in identifying ischaemic patients was 96.6%. Lacunar syndromes due to non ischaemic causes are not rare; since CT scan allowed appropriate treatment in two patients and demonstrated contraindications to antithrombotic therapy in five others, its early use appears warranted in patients with acute lacunar syndromes, particularly if normotensive.
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