VASCULAR RISK-FACTORS LINKED TO MULTIPLE LACUNAR INFARCTS

Background: The pathogenesis of lacunar infarcts is still incompletely established. Data from the literature suggest that vascular risk fact ors differ among patients with multiple (MLI) and single lacunar infar cts (SLI). We reexamined this hypothesis using stricter inclusion crit eria and a less selected study population. Methods: We evaluated 136 p atients consecutively admitted for first-ever minor stroke to a genera l hospital with the characteristics of a community hospital. Vascular risk factors were studied by univariate and multivariate statistical a nalyses among the following subgroups of patients, classified accordin g to CT findings: (a) with lacunar infarct; (b) with nonlacunar infarc t (NLI); (c) with SLI; (d) with MLI; (e) with single, either lacunar o r nonlacunar, infarct. Results: No significant difference was observed between patients with lacunar infarcts and patients with NLI. Compare d to patients with SLI or NLI, patients with MLI had significantly mor e often a family history of hypertension, cardiomegaly on the chest ra diograph and CT leukoaraiosis as well as a higher systolic and diastol ic blood pressure on admission. Logistic regression analysis selected CT leukoaraiosis, Rx cardiomegaly and admission diastolic blood pressu re as independent, significant predictors of MLI. Conclusion: In patie nts with first-ever minor stroke, the risk factor profile differs acco rding to the evidence of SLI or MLI on the CT scan. In terms of risk f actors, patients with SLI seem more similar to those with NLI than tho se with MLI. Based on the predicting effect of variables linked with t ype and severity of arterial hypertension, the CT appearance of MLI mi ght express a more univocal and specific cerebrovascular pathology (hy pertensive arteriolosclerosis).