Clinical diagnosis of lacunar infarcts is unreliable, according to results of a study published in the August issue of Stroke. Diffusion-weighted (DWI) and perfusion-weighted (PWI) magnetic resonance imaging (MRI) changed the diagnosis from small perforating artery occlusion to large artery embolism in 13 of 19 patients.
“The clinical diagnosis of subcortical cerebral infarction is inaccurate for lesion location and pathogenesis,” write Richard P. Gerraty, MD, FRACP, and colleagues from Royal Melbourne Hospital in Victoria, Australia. “Clinically suspected small perforating artery occlusions may be embolic infarcts, with important implications for investigation and treatment.”
From a prospective series of 106 patients who received acute DWI and PWI within 24 hours of stroke, the investigators enrolled 19 with clinical evidence of a lacunar syndrome, including 13 with pure motor stroke, two with ataxic hemiparesis, and four with sensorimotor stroke.
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