Long-term morphological changes of symptomatic lacunar infarcts and surrounding white matter on structural MRI

Background and Purpose – Insights into evolution of cerebral small vessel disease on neuroimaging might advance knowledge of the natural disease course. Data on evolution of sporadic symptomatic lacunar infarcts are limited. We investigated long-term changes of symptomatic lacunar infarcts and surrounding white matter on structural MRI.
Methods - From two non-overlapping single centre, prospective observational stroke studies, we selected patients presenting with lacunar stroke symptoms with a recent small subcortical (lacunar) infarct on baseline structural MRI and with follow-up MRI available at one to five years. We assessed changes in imaging characteristics of symptomatic lacunar infarcts and surrounding white matter.
Results – We included 79 patients of whom 32/79 (41%) had complete and 40/79 (51%) had partial cavitation of the index lesion at median follow-up of 403 (range 315-1781) days. In 42/79 (53%) patients, we observed a new white matter hyperintensity adjacent to the index infarct, either superior (white matter hyperintensity ‘cap’, n=17), inferior (white matter hyperintensity ‘track’, n=13), or both (n=12).
Conclusions – Half of sporadic symptomatic lacunar infarcts developed secondary changes in superior and/or inferior white matter. These white matter hyperintensity ‘caps’ and ‘tracks’ may reflect another aspect of cerebral small vessel related disease progression. The clinical and prognostic value remain to be determined