2 CLINICALLY DISTINCT LACUNAR INFARCT ENTITIES - A HYPOTHESIS

Background and Purpose: We investigated the hypothesis that patients w ith one or more asymptomatic lacunar infarcts and those with only one symptomatic lacunar infarct represent two clinically distinct lacunar infarct entities. Methods: In a prospective series of 100 lacunar infa rct patients, univariate and multivariate logistic regression analysis was performed on clinical features, vascular risk factors, and leukoa raiosis between patients with and without asymptomatic lacunar infarct s. Results: Patients with asymptomatic lacunar infarcts had hypertensi on significantly more often (71% versus 43%; [crude] odds ratio, 3.31; 95% confidence intervals, 1.16-9.43; p<0.05) and had leukoaraiosis si gnificantly more often (71% versus 19%; [crude] odds ratio, 10.67; 95% confidence intervals, 3.81-32.10; p<0.001) than those with only a sym ptomatic lacunar infarct. After multivariate logistic regression analy sis, only leukoaraiosis was significantly associated with the presence of asymptomatic lacunar infarcts. The asymptomatic lacunar infarcts d iffered in location, involved vascular territory, and volume from the symptomatic infarcts. Conclusions: Two distinct lacunar infarct entiti es might be broadly distinguished during life: lacunar infarct patient s with a single, symptomatic lacunar infarct, and patients with multip le lacunar infarcts and a high frequency of hypertension and leukoarai osis, in which the underlying small-vessel vasculopathy might be diffe rent.