The Appearance of a New White Matter Lesion Adjacent to the Old Infarct in First-Ever Lacunar Stroke Patients: A Two-Year Follow-Up Study with MRI

Results Characteristics of 82 patients are shown in table 1 . In 15 cases (18%), we observed a new WML in the zone distal to the old lacunar infarct. An example is given in figure 1 . One of these patients had a transient ischemic attack during follow-up, with clinical symptoms similar to the former lacunar stroke syndrome; none had deterioration of stroke symptoms with poor outcome or a recurrent stroke during follow-up. Lacunar infarcts are presumed to be caused by occlusion of a single deep perforating artery [1] . White matter lesions (WMLs) might be caused by chronic hypoperfusion leading to ischemia or blood-brain barrier damage [2, 3] . In a follow-up MRI study in lacunar stroke patients, we observed a new WML in the zone adjacent to and just distal (in the vascular territory) from the old infarct in some of the cases. Subsequently, we reviewed all 2-year follow-up scans of our lacunar stroke patient cohort for this particular imaging feature. We describe this imaging feature and discuss a possible mechanism for these WMLs.