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

Figures & data

Table 1 Definition of symptomatology

Term	Definition
Transient ischemic attack (TIA)	TIA is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction^Citation1
Transient symptoms with LI (TSI)	Defined as focal or nonfocal cerebrovascular symptoms lasting less than 24 hours and patients with LI on DWI or FLAIR
Persistent symptoms with LI (PSI)	PSI Defined as focal or nonfocal cerebrovascular symptoms lasting more than 24 hours and patients with LI on DWI or FLAIR
White matter lesions	Defined as bilateral, symmetrical, and diffuse hyperintensities, which were located in the subcortical and periventricular white matter with T2-weighted images and prone density images
Vascular subsequent events (VSE)	VSE defined as TIAs, transient nonfocal cerebrovascular symptoms or deterioration of cerebrovascular symptoms or recurrent infarction, and plus a modified Rankin scale (mRS) ≥2 scores during a follow-up

Abbreviations: DWI, diffusion-weighted images; FLAIR, fluid-attenuated inversion recovery; LI, lacunar infarction.

Table 2 The baseline characteristics in LI patients with TSI and PSI

Episodes	All (n=251)	TSI (n=194)	PSI (n=57)	P-value
Risk factors
Male sex (%)	125 (49.8)	92 (47.4)	33 (57.9)	0.164
Age (years, mean ± SD)	60.2±11.3	58±10.3	68±10.9	0.000
BMI (kg/m^2, mean ± SD)	24.0±3.2	24.1±3.3	23.4±2.5	0.290
Duration of hypertension (years, mean ± SD)	3.1±5.0	2.7±4.4	4.4±6.6	0.020
Diabetes mellitus (%)	20 (8.0)	14 (7.2)	6 (10.5)	0.417
Dyslipidemia (%)	144 (57.4)	106 (54.6)	38 (66.7)	0.106
Heart disease (%)	7 (3.0)	4 (2.1)	3 (5.3)	0.197
Atrial fibrillation (%)	2 (0.8)	2 (1.0)	0 (0)	0.442
Current smoking (%)	62 (24.7)	46 (23.7)	16 (28.1)	0.502
Heavy alcohol drinker (%)	61 (24.3)	51 (26.3)	10 (17.5)	0.176
Symptoms features
Periodic duration of episodes (days, range)	147 (0.1–2,879)	20 (0.2–2,880)	7 (0.1–1,080)	0.307
Headache/migraine (%)	56 (22.3)	55 (28.4)	1 (1.8)	0.000
Dizziness/vertigo (%)	77 (30.7)	60 (30.9)	17 (29.8)	0.874
Headache and dizziness (%)	71 (28.3)	53 (27.3)	18 (31.6)	0.530
Pure sensory stroke (%)	33 (13.1)	22 (11.3)	11 (19.3)	0.118
Pure motor hemiparesis (%)	10 (4.0)	2 (1.0)	8 (14.0)	0.000
Sensorimotor syndrome (%)	1 (0.4)	0 (0)	1 (1.8)	0.065
Ataxic-hemiparesis (%)	1 (0.4)	1 (0.5)	0 (0)	0.587
Dysarthria-clumsy hand (%)	1 (0.4)	1 (0.5)	0 (0)	0.587
Cognitive impairment (%)	1 (0.4)	0 (0)	1 (1.8)	0.065
Median number of lesions on MRI (range)	10.6 (1–109)	5.6(1–48)	13 (1–110)	0.000
Median size of lacular (mm, range)	5.0 (2–9)	4 (2–10)	7.5 (2–20)	0.000
Anterior circulation (%)	140 (55.8)	122 (62.9)	18 (31.6)	0.000
Posterior circulation (%)	8 (3.2)	6 (3.1)	2 (3.5)	0.875
Anterior and posterior circulation (%)	113 (45.0)	66 (34.0)	37 (64.9)	0.000
White matter lesions (%)	12 (4.8)	6 (3.1)	8 (14.0)	0.002
Initial median NIHSS score (range)	0.7 (0–6)	0.05(0–2)	1 (0–3)	0.000
Initial ABCD2 score (mean ± SD)	5.0±1.2	4.8±1.1	6.0±1.0	0.000
Mortality (%)	2 (0.8)	0 (0)	2 (3.5)	0.009
Vascular subsequent event (%)	91 (36.3)	60 (30.9)	31 (54.4)	0.000

Note: Scores range from 0 to 7, with higher scores indicating greater risk of stroke.

Abbreviations: BMI, body mass index; LI, lacunar infarction; MRI, magnetic resonance imaging; NIHSS, National Institutes of Health Stroke Scale; PSI, persistent symptoms with LI; TSI, transient symptoms with LI; ABCD2, age, blood pressure, clinical features, duration of symptoms, and presence or absence of diabetes.

Table 3 Multivariate analysis of the association of the early predictors for LI patients with TSI and PSI

Episodes	TSI (n=194)	PSI (n=57)	RR (95% CI)	P-value
Age (years, mean ± SD)	58±10.3	68±10.9	1.1 (1.157–1.189)	0.000
Initial median NIHSS score (range)	0.05 (0–2)	1 (0–4)	20.6 (6.705–13.31)	0.000
Median size of lacunae on MRI (mm, range)	4 (2–10)	7.5 (2–20)	2.9 (1.960–4.245)	0.000
LI in anterior circulation (%)	122 (62.9)	18 (31.6)	0.2 (0.079–0.721)	0.011

Abbreviations: CI, confidence interval; LI, lacunar infarction; MRI, magnetic resonance imaging; NIHSS, National Institutes of Health Stroke Scale; PSI, persistent symptoms with LI; RR, risk ratio; TSI, transient symptoms with LI.

Figure 1 Kaplan–Meier survival curves for patients with TSI and PSI.

Abbreviations: LI, lacunar infarction; PSI, persistent symptoms with LI; TSI, transient symptoms with LI.

Figure 2 Kaplan–Meier subsequent events curves for patients with TSI and PSI.

Abbreviations: LI, lacunar infarction; PSI, persistent symptoms with LI; TSI, transient symptoms with LI.

EastonJDSaverJLAlbersGWDefinition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke AssociationStroke2009402276229319423857

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