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Lacunar Syndromes--Where is the Lesion?

OBJECTIVES
The study aimed to evaluate different imaging localizations of the classical Lacunar syndromes, including multiplicity of lacunes.


MATERIALS AND METHODS
This prospective study was conducted in a tertiary care municipal hospital over 2 years. Patients with clinical Lacunar syndromes, confirmed on imaging, were evaluated for etiopathogenetic factors, lesion localization, and presence of multiple simItaneous lacunes. Angiographic data and cognitive evaluation was done in a subset of the cohort.


RESULTS
82 patients were studied, 12 undergoing DSA and 46 being evaluated cognitively. Commonest risk factors were Hypertension (97%) and tobacco usage (62%). Pure motor stroke (PMS-70.7%) was the commonest lacunar syndrome, Internal capsular lesions accounting for 53.4% of this syndrome. Among PMS, localisation to Carotid territory was seen in 84.4%, to vertebrobasilar territory in 10.3% and to both in 5.1% of patients. Sensorimotor lacunar syndrome was seen in 14.6% patients, half of them having a thalamic lesion. Overall, 17% patients had multiple simultaneous lacunes, over half of these being cortical, and multiplicity being seen in PMS most commonly. Of 46 patients tested for cognition, 69.5% showed significantly low scores on ACER, with a significant association with multiplicity of lacunes in this group.


CONCLUSIONS
In our study, Pure motor stroke was the commonest lacunar syndrome, 84% of PMS being due to Anterior circulation stroke. Multiple lacunes of similar age were seen in 17% patients, the predominantly cortical localization of these raising a possibility of embolism. Postlacunar stroke executive dysfunction was seen in over two-thirds of our patients.