Transient and persistent symptoms in patients with lacunar infarction: results from a prospective cohort study

Abstract

Ye-Ting Zhou,1 Guang-Sheng Wang,2 Xiao-Dong Chen,2 Tong-Hui Yang,2 Dao-Ming Tong2,3 1Department of Clinical Research, 2Department of Neurology, Affiliated Shuyang People' Hospital, XuZhou Medical University, Jiangsu, 3Department of Neurology, the Affiliated Pingxiang Hospital, Southern Medical University, Pingxiang, People's Republic of China Background: The transient symptoms with lacunar infarction (TSI) and persistent symptoms with lacunar infarction (PSI) are the most common forms of symptomatic lacunar infarction (LI). The aim of this study was to compare the differences in TSI and PSI of symptomatic LI. Methods: A prospective cohort study was conducted in the neurologic outpatients of the tertiary teaching hospital in Northern China between February 2011 and February 2012. The TSI and PSI in participants aged 35 years or over were assessed. Patients were followed up and their outcomes were compared. Results: Of the 453 symptomatic outpatients, 251 patients with LI were diagnosed by magnetic resonance imaging. Approximately 77.3% (194/251) of the patients with LI at this time had TSI. and the remaining 23.7% had PSI. After the adjusted odds ratios, only middle age (risk ratio [RR], 1.1; 95% confidence interval [CI], 1.157–1.189), lower National Institutes of Health Stroke Scale score (RR, 20.6; 95% CI, 6.705–13.31), smaller lacunae on brain images (RR, 2.9; 95% CI, 1.960–4.245), and LI frequently in the anterior circulation territory (RR, 0.2; 95% CI, 0.079–0.721) were independently associated with TSI. During a mean follow-up of 6 months, survival rate was significantly higher among patients with TSI than among those with PSI (log rank, 6.9; P=0.010); estimated unadjusted incidence of vascular subsequent events (30.9% vs 54.4%, P=0.001) was significantly lower in TSI than in PSI. Conclusion: The TSI has a higher prevalence and is associated with a lower risk of vascular subsequent events and death than PSI. The implications of these findings for TSI and PSI may require different interventions. Keywords: lacunar infarction, magnetic resonance imaging, ischemic stroke, outcome