[Type of syndrome, location, size and etiology of capsular lacunar infarction].

ABSTRACT

We investigated the types of clinical syndrome, location, sizes and presumed causes of 49 patients with capsular lacunar infarction. Clinical syndromes were classified according to Fisher's criteria into pure motor hemiparesis (PM), sensorimotor stroke (SM) and ataxic hemiparesis (AH) including dysarthria clumsy hand syndrome. Cases who had higher brain dysfunctions or brainstem syndromes were excluded. The size of infarcts was expressed as the volume on brain CT. All patients underwent 12-lead ECG and 2-dimension echocardiography. Twenty three patients (47%) underwent angiography or carotid ultrasonography. Lesion sites on CT were divided into three groups, i.e., perforating branch of ACA (PACA), perforating branch of MCA (PMCA) and anterior choroidal artery (AC). Lesion sizes of AH were significantly smaller than those of SM and tended to be smaller than those of PM. In AH patients, no cardioembolic sources nor large arterial lesions could be detected, whereas 40% in SM patients and 30% in PM patients had cardioembolic sources and 33% in SM patients and 75% of PM patients had large arterial lesions. The lesion volume was classified into two groups, larger and smaller than 1 ml. The larger volume group had more frequent cardioembolic sources than the small volume group (42% and 17% respectively, p less than 0.05), but no significant difference in frequency of large artery lesions was found among the two groups. Patients with "large striatocapsular infarct" had frequent cardiac and arterial lesions (60% and 40% respectively). Patients with AC territory infarction had more infrequent but not significant cardiac and arterial lesions than patients with PMCA territory infarction. All patients with PACA territory infarction presented PM.(ABSTRACT TRUNCATED AT 250 WORDS)