Lacunar syndromes: Are they all equally benign?

Background There is a paucity of prognostic data following clinical lacunar syndromes, particularly comparisons between the various lacunar syndromes. Aims To compare the outcomes, disability at discharge, at 1 and 3 months, use of rehabilitation facilities and duration to return to work/daily activities, between patients with various clinical lacunar syndromes. Methods Ischemic stroke patients with clinical lacunar syndromes were prospectively recruited. Functional outcomes were measured by the modified Rankin Scale (mRS), with unfavorable outcome defined as mRS > 1. Use of rehabilitation facilities and duration to return to work/ daily activities was also ascertained. Logistic regression analyses were performed to determine predictors of outcome measures. Results Of the 192 ischemic stroke patients (mean age 62 ± 11 years) with clinical lacunar syndromes, 72(37%) patients had ataxic hemiparesis, 53(28%) patients had pure motor syndrome, 41(21%) had sensorimotor syndrome, 17(9%) had pure sensory syndrome, and 9(5%) had clumsy hand dysarthria syndrome. Compared to pure sensory strokes, patients with pure motor syndrome (OR 7.72 CI 1.5‐38), sensorimotor syndrome (OR 6.06, CI 1.18‐31), and ataxic hemiparesis (OR 18.1 CI 3.79‐91) were more likely to have unfavorable outcome at 1 month, but there was no difference at 3 months. There was no independent association between specific lacunar syndromes with use of rehabilitation facilities and duration to return to work/ daily activities. Conclusions Nearly 1/3 of patients with clinical lacunar syndromes have unfavorable 3‐month functional outcome. There were differences in the functional status at discharge between clinical lacunar syndromes, but not for other outcomes.