Variation in risk factors for recent small subcortical infarcts with infarct size, shape, and location

Alessandra Del Bene, Stephen D. J. Makin, Fergus N. Doubal, Domenico Inzitari, Joanna M. Wardlaw

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61 Citations (Scopus)


BACKGROUND AND PURPOSE: Lacunar infarction is attributable to a perforating arteriolar abnormality. Possible causes include embolism, atheromatosis, or intrinsic disease. We examined whether the size, shape, or location of the lacunar infarct varied with embolic sources, systemic atheroma, or vascular risk factors. METHODS: We examined data from 3 prospective studies of patients with clinical and diffusion-weighted imaging-positive symptomatic lacunar infarction who underwent full clinical assessment and investigation for stroke risk factors. Lacunar infarct sizes (maximum diameter; shape, oval/tubular; location, basal ganglia/centrum semiovale/brain stem) were coded blind to clinical details. RESULTS: Among 195 patients, 48 infarcts were tubular, 50 were 15 to 20 mm in diameter, and 97 and 74 were located in the basal ganglia and the centrum semiovale, respectively. There was no association between infarct size or shape and any of the risk factors. Centrum semiovale infarcts were less likely to have a potential relevant embolic source (4% versus 11%; odds ratio, 0.16; 95% confidence interval, 0.03-0.83) and caused a lower National Institute of Health Stroke Scale score (2 versus 3; odds ratio, 0.78; 95% confidence interval, 0.62-0.98) than basal ganglia infarcts. There were no other differences by infarct location. CONCLUSIONS: Lacunar infarcts in the basal ganglia caused marginally severer strokes and were 3 times more likely to have a potential embolic source than those in the centrum semiovale, but the overall rate of carotid or known cardiac embolic sources (11%) was low. We found no evidence that other risk factors differed with location, size, or shape, suggesting that most lacunar infarcts share a common intrinsic arteriolar pathology.
Original languageEnglish
Pages (from-to)3000-3006
Number of pages7
Issue number11
Early online date5 Sept 2013
Publication statusPublished - Nov 2013

Bibliographical note

Sources of Funding
Edinburgh Patients: the studies were funded by The Chief Scientist Office of the Scottish Executive (CZB/4/281); the Wellcome Trust (075611 and WT088134/Z/09/A), the Row Fogo Charitable Trust, and the Cohen Charitable Trust supported the study. The imaging was conducted in the Brain Research Imaging Centre, University of Edinburgh (, a center in the Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration. Florence patients: PhD program of the University of Florence and the Health Targeted Research Programme, Italian Ministry of Health 2008.


  • pathogenesis
  • pathology
  • stroke
  • stroke, lacunar


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