PRESUMED PATHOGENETIC MECHANISMS OF RECURRENT STROKE AFTER LACUNAR INFARCTION

We report presumed mechanisms of recurrent stroke in a prospective stu dy on patients with lacunar infarction. Eighty-one patients with clini cal and magnetic resonance imaging (MRI) findings compatible with lacu nar infarction were followed for a median time of 48 months. Patients with recurrent stroke were assessed clinically by computed tomography, contrast-enhanced MRI and with respect to large-artery disease and ca rdioembolic sources of embolism. During follow-up, 9 patients (11.1%) died and 20 patients (24.7%) had 27 recurrent strokes (3 hemorrhagic, 24 ischemic). The annual risk of recurrent stroke was 6.8% and approxi mately even with time. Univariate analysis revealed age as the only ri sk factor significantly associated with recurrent stroke. Out of 24 ep isodes of recurrent ischemic stroke, 16 had clinical and neuroimaging features compatible with small penetrating artery occlusion, 6 were du e to cortical infarcts, 1 episode was caused by presumed cerebral amyl oid angiopathy, and 1 by a retinal infarct. Relevant large-artery dise ase was diagnosed in 2 patients with recurrent, small brainstem infarc ts and in 2 patients with recurrent cortical and retinal infarcts. Alt hough presumed lacunar infarcts predominated, our series highlights th e heterogeneity of recurrent strokes after lacunar infarcts.