lacunar syndrome

Q: Pure motor hemiparesis can occur as a lacunar syndrome.

A) True

B) False

Answer: A

Lacunar infarcts are small i.e., about 2 to 15 mm in diameter noncortical infarcts. These occur by occlusion of a single penetrating branch of a large cerebral artery. Infarct occurs as these branches arise at acute angles from the large arteries of the circle of Willis, the stem of the middle cerebral artery (MCA), or the basilar artery. 

An expert clinician can make a preliminary diagnosis just by physical examination prior to any radiological tests. This led to the concept of lacunar syndromes. The five classic lacunar syndromes, which may present as transient ischemic attacks (TIAs) in addition to stroke, are named according to their clinical manifestations:

• Pure motor hemiparesis
• Pure sensory stroke
• Ataxic hemiparesis
• Sensorimotor stroke
• Dysarthria-clumsy hand syndrome

Said above, all patients with acute ischemic stroke should be evaluated to determine eligibility for reperfusion therapy and/or mechanical thrombectomy.

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References:

1. Giacomozzi S, Caso V, Agnelli G, Acciarresi M, Alberti A, Venti M, Mosconi MG, Paciaroni M. Lacunar stroke syndromes as predictors of lacunar and non-lacunar infarcts on neuroimaging: a hospital-based study. Intern Emerg Med. 2020 Apr;15(3):429-436. doi: 10.1007/s11739-019-02193-2. Epub 2019 Sep 18. PMID: 31535289.

2. Arboix A, Massons J, García-Eroles L, Targa C, Comes E, Parra O. Clinical predictors of lacunar syndrome not due to lacunar infarction. BMC Neurol. 2010 May 18;10:31. doi: 10.1186/1471-2377-10-31. PMID: 20482763; PMCID: PMC2877662.