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

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    Rights statement: © 2018 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.

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Original languageEnglish
Early online date22 Mar 2018
Publication statusE-pub ahead of print - 22 Mar 2018


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

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