Pathogenetic and prognostic features of lacunar transient ischaemic attack syndromes

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 56; no. 12; pp. 1265 - 1270
• Main Authors: Landi, G, Motto, C, Cella, E, Musicco, M, Lipari, S, Boccardi, E, Guidotti, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: London BMJ Publishing Group Ltd 01-12-1993; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Female; Humans; Ischemic Attack, Transient - epidemiology; Ischemic Attack, Transient - physiopathology; Male; Medical sciences; Middle Aged; Neurology; Prognosis; Prospective Studies; Survival Analysis; Syndrome; Vascular diseases and vascular malformations of the nervous system; Human; Nervous system diseases; Prognosis; Ischemia; Pathogenesis; Cerebrovascular insufficiency; Cerebral lacuna; Cardiovascular disease; Transitory
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.56.12.1265

Lacunar ischaemic stroke syndromes are a well defined subgroup of ischaemic strokes. To determine whether a similar subgroup can be identified among patients with transient ischaemic attacks (TIAs) we studied prospectively 102 consecutive patients within 24 hours of their first TIA. Based on their history they were classified as lacunar TIA syndromes (LTIAS; n = 45) if isolated motor or sensory symptoms or their combination 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 standardised protocol and followed up for an average of 51.1 months. Cardiac and arterial sources of thromboembolism were more frequent among NLTIAS (p = 0.0001). Survival curve analysis demonstrated that LTIAS had a significantly lower long term mortality and incidence of major vascular events. In a multivariate regression analysis, the type of TIA (that is, NLTIAS) was an independent predictor of stroke or death. LTIAS share the same distinct pathogenetic and prognostic features of lacunar ischaemic stroke syndromes. These findings have implications for management of TIAs and for studies of their natural history and treatment.