PATHOGENETIC AND PROGNOSTIC FEATURES OF LACUNAR TRANSIENT ISCHEMIC ATTACK SYNDROMES

Lacunar ischaemic stroke syndromes are a well defined subgroup of isch aemic strokes. To determine whether a similar subgroup can be identifi ed among patients with transient ischaemic attacks (TIAs) we studied p rospectively 102 consecutive patients within 24 hours of their first T LA. Based on their history they were classified as lacunar TIA syndrom es (LTIAS; n = 45) if isolated motor or sensory symptoms or their comb ination had involved at least two of three body parts (face, arm, leg) , whereas all other subjects were grouped as non-lacunar TIA syndromes (NLTIAS; n = 57). All patients were investigated according to a stand ardised protocol and followed up for an average of 51.1 months. Cardia c and arterial sources of thromboembolism were more frequent among NLT IAS (p = 0.0001). Survival curve analysis demonstrated that LTIAS had a significantly lower long term mortality and incidence of major vascu lar events. In a multivariate regression analysis, the type of TIA (th at is, NLTIAS) was an independent predictor of stroke or death. LTIAS share the same distinct pathogenetic and prognostic features of lacuna r ischaemic stroke syndromes. These findings have implications for man agement of TIAs and for studies of their natural history and treatment .