PURE MOTOR HEMIPARESIS AND SENSORIMOTOR STROKE - ACCURACY OF VERY EARLY CLINICAL-DIAGNOSIS OF LACUNAR STROKES

Background and Purpose Clinical differentiation of lacunar from nonlac unar strokes in the very early phase could help to exclude patients wi th lacunar stroke from pharmacologic trials designed for nonlacunar st rokes, namely, those with thrombolytic agents. In a continuous series of acute ischemic stroke patients, we evaluated how accurately a clini cal diagnosis of pure motor hemiparesis or sensorimotor stroke formula ted in the first hours from onset predicts a lacunar stroke documented by cerebral computed tomography or by autopsy. Methods We examined 51 7 patients (299 men, 218 women; mean+/-SD age, 67+/-10 years) within 1 2 hours (mean+/-SD, 6.1+/-3.2 hours) of the event. At hospital admissi on, we observed 151 (29%) patients with pure motor hemiparesis and 68 (13%) patients with sensorimotor stroke. Results Computed tomography o r autopsy was compatible with a lacunar stroke (ie, detection of a lac une or permanently negative computed tomography) in 170 (33%) patients , of whom 123 (72%) had pure motor hemiparesis and 47 (28%) had sensor imotor stroke. This led to a sensitivity of 72%, a specificity of 72%, a positive predictive value of 56%, and a negative predictive value o f 84%. Overall positive predictive value of pure motor hemiparesis was 58% (60% for two areas and 58% for three areas involved), and that of sensorimotor stroke was 51% (87% for two areas and 40% for three area s involved). By separately evaluating the sides of lesions, we found a positive predictive value of 46% for right-side infarcts and of 72% f or left-side infarcts. Right-side lesions constituted 51% of lesions i n lacunar syndrome patients with lacunar stroke, 76% in those with non lacunar stroke, 19% in nonlacunar syndrome patients with lacunar strok e, and 31% in those with nonlacunar stroke (P<.0001). During the first days of hospital stay we observed a deterioration of 21% of lacunar s yndrome patients with nonlacunar stroke and an improvement of 49% of n onlacunar syndrome patients with lacunar stroke, with appearance and d isappearance of symptoms of cortical involvement, respectively. The ex amination of these patients after the occurrence of these clinical cha nges would have led to a daily increase of the positive predictive val ue up to a maximum of 66% at day 7. Conclusions Pure motor hemiparesis and sensorimotor stroke diagnosed within 12 hours of the event are po orly predictive of lacunar strokes. Hence, the very early identificati on of these syndromes cannot be used for patient selection in therapeu tic trials.