Differential Characteristics of Ischemic and Hemorrhagic Stroke in Patients with Cerebral Small Vessel Disease.

BACKGROUND: Small vessel disease (SVD) is the underlying anatomical substrate for both lacunar infarction and subcortical hemorrhage. AIM: To assess predictive factors of ischemic or hemorrhagic stroke in patients with cerebral SVD. MATERIALS AND METHODS: Prospective hospital-based stroke registry ("The Sagrat Cor Hospital of Barcelona Stroke Registry") in an acute-care teaching hospital in Barcelona, Spain. From 4597 acute stroke patients included in the stroke registry over a 24-year period, 440 cases of lacunar stroke and 210 of subcortical intracerebral hemorrhage were selected. Demographics, clinical characteristics, risk factors, and early outcome were compared. Predictors of lacuna versus subcortical hemorrhage were assessed by multivariate analyses. RESULTS: In a logistic regression model based on demographics, risk factors, clinical features and outcome, dyslipidemia (odds ratio [OR] 2.06 (95% confidence interval (CI) 1.17-3.62) and diabetes (OR 1.97, 95% CI 1.19-3.26) were independent risk factors for lacunar infarction. Anticoagulation therapy (OR 0.05, 95% CI 0.01-0.28), sudden onset (OR 0.51, 95% CI 0.33-0.78), motor symptoms (OR 0.44, 95% CI 0.26-0.76), headache (OR 0.23, 95% CI 0.12-0.41), altered consciousness (OR 0.10, 95% CI 0.05-0.21), respiratory complications (OR 0.19, 95% CI 0.08-0.46), and in-hospital death (OR 0.08, 95% CI 0.02-0.36) were predictors of subcortical hemorrhage. CONCLUSION: Identification of differential clinical and prognostic profile between ischemic and hemorrhagic consequences of underlying cerebral SVD is useful for risk stratification in the current process pursuing precision medicine.

Perfil clínico diferencial entre los infartos lacunares y los infartos cerebrales aterotrombóticos / Differential clinical profile of lacunar infarcts compared to atherothrombotic brain infarcts

Aims and objectives: The present study makes a comparative analysis between the clinical profile of lacunar infarcts (LI) and that of atherothrombotic brain infarcts (ABI). Methods: Hospital-based descriptive study of 1809 consecutive patients admitted over a period of 24 years with a diagnosis of lacunar cerebral infarction (n = 864) or atherothrombotic cerebral infarction (n = 945). A comparative analysis of the demographic data, cerebral vascular risk factors, clinical data and hospital evolution between both subtypes of cerebral infarction was performed using a univariate and multivariate statistical methodology. Results: LI accounted for 26.5% and ABI for 28.9% of all cerebral infarctions in the registry. The variables directly and independently associated with ABI were: ischemic heart disease, previous transient ischemic attack, previous cerebral infarction, peripheral vascular disease, anticoagulant therapy, age > 85 years, vegetative symptoms, decreased level of consciousness, sensory deficit, visual deficit, speech disorders, and neurological, respiratory and urinary complications during hospital admission. In contrast, the absence of neurological symptoms at hospital discharge was directly associated with LI. Conclusions: LI and ABI have a distinct clinical profile. The best functional prognosis of LI during the acute phase of the disease is characteristic. In contrast, ICAs have a higher atherosclerotic burden and a worse prognosis.

Fundamentos y objetivo: El objetivo del estudio es efectuar un análisis comparativo entre el perfil clínico de los infartos lacunares (IL) y el perfil de los infartos cerebrales aterotrombóticos (ICA). Métodos: Estudio hospitalario descriptivo de 1809 pacientes consecutivos ingresados durante un período de 24 años con el diagnóstico de infarto cerebral de tipo lacunar (n = 864) o por infarto cerebral aterotrombótico (ICA) (n = 945). Se realizó un análisis comparativo de los datos demográficos, factores de riesgo vascular cerebral, datos clínicos y de evolución hospitalaria utilizando una metodología estadística univariada y, posteriormente, multivariada. Resultados: Los IL representaron el 26.5% y los ICA el 28.9% del total de infartos cerebrales del registro. Las variables asociadas directamente y de forma independiente con los ICA fueron: cardiopatía isquémica, ataque isquémico transitorio previo, infarto cerebral previo, enfermedad vascular periférica, uso de anticoagulantes, edad > 85 años, síntomas vegetativos, disminución del nivel de conciencia, déficit sensitivo, déficit visual, trastornos del habla y complicaciones neurológicas, respiratorias y urinarias durante el ingreso hospitalario. En cambio, la ausencia de sintomatología neurológica al alta se asoció directamente con los IL. Conclusiones: Los IL y los ICA tienen un perfil clínico diferenciado. Es característico el mejor pronóstico funcional de los IL durante la fase aguda de la enfermedad. En cambio, los ICA presentan mayor carga aterosclerótica y peor pronóstico evolutivo.