Comparison of risk factor profile, severity and outcome between lacunar strokes & other ischaemic stroke subtypes

Abstract

Objective: Lacunar infarcts are a frequent type of stroke caused mainly by cerebral small-vessel disease.  Because of this, lacunar infarcts are likely to behave differently from other ischaemic stroke subtypes and may require a different approach in their management. Objective was to describe the differences in risk factor profile, severity and outcome between lacunar and other ischaemic stroke subtypes as this aspect had not been studied in Srilankan patients.

Methods: This prospective descriptive study included 70 patients with acute ischaemic strokes admited to Colombo South Teaching Hospital during 01/06/2012 to 10/09/2012. Severity of the stroke was assessed by using The National Institutes of Health Stroke Scale (NIHSS). Assessment of the outcome was done by estimating disability using Modified Rankin Scale (MRS) by contacting the patient via telephone after one month of hospital discharge.

Results: In this period of time 46 patients with lacunar strokes and 26 with other types of ischaemic stroke were evaluated. Hypertension (58.7% Vs 54.2%) and Diabetes mellitus (45.7% Vs 45.8%) were equally common in lacunar and non lacunar stroke. Hypercholesterolemia (32.6% Vs 12.5%) was more frequent in lacunar stroke and chronic atrial fibrillation (4.2% Vs 2.2%) was more frequent in non lacunar stroke patients. Regarding severity, 56.5% of lacunar stroke patients had minor stroke (NIH stroke scale 1-4) while 62.5% of non lacunar patients had moderate stroke (NIH stroke scale 5-15)(P value = 0.02). With regard to outcome following stroke, 63% of lacunar strokes and 45.8% of non lacunar strokes were independent (MRS<3) after one month.

Conclusion: Lacunar strokes appear to cause less disability and their outcome too is better.  Risk factors did not show a significant difference, but a larger study is needed to confirm this.