Division of Clinical Neurosciences and SINAPSE Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom.
Stroke. 2010 Feb;41(2):267-72. doi: 10.1161/STROKEAHA.109.566307. Epub 2009 Dec 31.
On brain imaging, lacunes, or cerebrospinal fluid-containing cavities, are common and are often counted in epidemiological studies as old lacunar infarcts. The proportion of symptomatic lacunar infarcts that progress to lacunes is unknown. Noncavitating lacunar infarcts may continue to resemble white matter lesions.
We identified patients with acute lacunar stroke, with or without an acute lacunar infarct on computed tomography or MRI, who had follow-up imaging. A neuroradiologist classified lacunar infarcts progressing to definite or possible cavities on follow-up imaging. We tested associations between cavitation and patient-related, stroke-related, and imaging-related features, including other features of small vessel disease.
Among 90 patients (mean age 67 years), any cavitation was present on follow-up imaging in 25 (28%), and definite cavitation in 18 (20%). Definite cavitation was associated with increasing time to follow-up imaging (median 228 days, range 54 to 1722, versus no cavitation 72 days, range 6 to 1440; P=0.0003) and deep cerebral atrophy (P=0.03) but not with age, stroke severity, larger initial infarct size, or other features of small vessel disease. Hypertension and diabetes were negatively associated with cavitation (P=0.01 and 0.02, respectively).
Definite cavitation occurs in one fifth of symptomatic lacunar ischemic strokes, implying that most continue to resemble white matter lesions. Epidemiology and pathophysiology studies of lacunar stroke, which have only counted lacunes as lacunar infarcts, may have substantially underestimated by as much as 5 times the true burden of lacunar stroke disease.
在脑成像中，腔隙或含脑脊液的腔隙很常见，在流行病学研究中常被计数为陈旧性腔隙性梗死。症状性腔隙性梗死进展为腔隙的比例尚不清楚。非空洞性腔隙性梗死可能继续类似于脑白质病变。
我们确定了患有急性腔隙性卒中的患者，这些患者有或没有计算机断层扫描或磁共振成像上的急性腔隙性梗死，并进行了随访成像。神经放射科医生根据随访成像将腔隙性梗死进展为明确或可能的空洞进行分类。我们测试了空洞与患者相关、卒中相关和成像相关特征之间的关联，包括小血管疾病的其他特征。
在 90 例患者（平均年龄 67 岁）中，25 例（28%）在随访成像上存在任何空洞，18 例（20%）存在明确空洞。明确空洞与随访成像时间延长相关（中位数 228 天，范围 54 至 1722 天，而无空洞为 72 天，范围 6 至 1440 天；P=0.0003）和深部脑萎缩（P=0.03）有关，但与年龄、卒中严重程度、较大的初始梗死灶或小血管疾病的其他特征无关。高血压和糖尿病与空洞呈负相关（P=0.01 和 0.02）。
症状性腔隙性缺血性卒中中有五分之一发生明确空洞，这意味着大多数继续类似于脑白质病变。只将腔隙计数为腔隙性梗死的腔隙性卒中的流行病学和病理生理学研究可能大大低估了腔隙性卒中疾病的真实负担，低估了多达 5 倍。
