eMedicine Specialties > Physical Medicine and Rehabilitation > Stroke

Lacunar Stroke: Follow-up

Author: Adam B Agranoff, MD, Physiatrist and Partner, Chelsea Back Care, Chelsea Community Hospital
Coauthor(s): Edward H Wong, MB, BCh, Stroke Fellow, Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario
Contributor Information and Disclosures

Updated: Jul 16, 2008

Follow-up

Further Inpatient Care

  • If the patient who has had a lacunar stroke is functionally independent, can return safely home, and would benefit from intensive inpatient rehabilitation, transfer him/her to a rehabilitation facility.

Further Outpatient Care

  • Outpatient physical, occupational, and/or speech therapy may be recommended for patients who have had a lacunar stroke.
  • Medical follow-up is necessary to assess neurologic and functional improvement, to monitor and treat risk factors, and to monitor drug compliance.

Inpatient & Outpatient Medications

  • Discharge on aspirin and ramipril.
  • If the patient remains nonambulatory and is at high risk of DVT, continue subcutaneous heparin.

Transfer

  • Transfer may be required for further diagnostic evaluation and treatment, including rehabilitation.

Complications

  • Stroke progression or recurrent stroke
  • Aspiration pneumonia
  • DVT and PE
  • Urinary tract infection
  • Depression
  • Shoulder-hand syndrome
  • Decubitus ulcers

Prognosis

  • Patient survival rates and rates of functional improvement are better for lacunar strokes than they are for other stroke subtypes (see Mortality/Morbidity).3,4,6
  • The risk of recurrent lacunar stroke, no more than 10% at 1 year, is no higher (and possibly is lower) than the recurrent stroke risk noted for other stroke subtypes.3,4

Patient Education

  • The patient and family should know the common stroke symptoms. Inform them early about the importance of presentation, because t-PA (which may be indicated) can be given only within 3 hours of stroke onset.14
  • For excellent patient education resources, visit eMedicine's Stroke Center. Also, see eMedicine's patient education article Stroke.

Miscellaneous

Medicolegal Pitfalls

  • Most complications of lacunes are preventable with good medical and nursing care.
 


More on Lacunar Stroke

Overview: Lacunar Stroke
Differential Diagnoses & Workup: Lacunar Stroke
Treatment & Medication: Lacunar Stroke
Follow-up: Lacunar Stroke
References
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References

  1. Bamford JM, Warlow CP. Evolution and testing of the lacunar hypothesis. Stroke. Sep 1988;19(9):1074-82. [Medline].

  2. Brenner D, Labreuche J, Pico F, et al. The renin-angiotensin-aldosterone system in cerebral small vessel disease. J Neurol. May 2 2008;[Medline].

  3. Sacco S, Marini C, Totaro R, et al. A population-based study of the incidence and prognosis of lacunar stroke. Neurology. May 9 2006;66(9):1335-8. [Medline].

  4. Bamford J, Sandercock P, Jones L, et al. The natural history of lacunar infarction: the Oxfordshire Community Stroke Project. Stroke. May-Jun 1987;18(3):545-51. [Medline].

  5. Bejot Y, Catteau A, Caillier M, et al. Trends in incidence, risk factors, and survival in symptomatic lacunar stroke in Dijon, France, from 1989 to 2006. A population-based study. Stroke. Apr 24 2008;[Medline].

  6. Mok VC, Wong A, Lam WW, et al. A case-controlled study of cognitive progression in Chinese lacunar stroke patients. Clin Neurol Neurosurg. May 2 2008;[Medline].

  7. Bang OY, Joo SY, Lee PH, et al. The course of patients with lacunar infarcts and a parent arterial lesion: similarities to large artery vs small artery disease. Arch Neurol. Apr 2004;61(4):514-9. [Medline]. [Full Text].

  8. Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. Jan 1993;24(1):35-41. [Medline].

  9. Jackson C, Sudlow C. Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke. Apr 2005;36(4):891-901. [Medline]. [Full Text].

  10. Inzitari D, Eliasziw M, Sharpe BL, et al. Risk factors and outcome of patients with carotid artery stenosis presenting with lacunar stroke. North American Symptomatic Carotid Endarterectomy Trial Group. Neurology. Feb 8 2000;54(3):660-6. [Medline].

  11. Nitkunan A, Barrick TR, Charlton RA, et al. Multimodal MRI in cerebral small vessel disease. Its relationship with cognition and sensitivity to change over time. Stroke. Apr 24 2008;[Medline].

  12. Rojas JI, Zurru MC, Romano M, et al. Transesophageal echocardiography findings in lacunar stroke. J Stroke Cerebrovasc Dis. May-Jun 2008;17(3):116-20. [Medline].

  13. The National Institute of Neurological Disorders and Stroke. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. Dec 14 1995;333(24):1581-7. [Medline]. [Full Text].

  14. Adams HP Jr, Brott TG, Furlan AJ, et al. Guidelines for thrombolytic therapy for acute stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation. Sep 1 1996;94(5):1167-74. [Medline]. [Full Text].

  15. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. Jan 20 2000;342(3):145-53. [Medline]. [Full Text].

  16. Pullicino PM, Caplan LR, Hommel M, eds. Cerebral Small Artery Disease. Advances in Neurology, vol 62. New York, NY: Raven Press; 1993.

  17. Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol. Feb 1979;36(2):65-73. [Medline].

  18. Fisher CM. The arterial lesions underlying lacunes. Acta Neuropathol. Dec 18 1968;12(1):1-15. [Medline].

  19. Gan R, Sacco RL, Kargman DE, et al. Testing the validity of the lacunar hypothesis: the Northern Manhattan Stroke Study experience. Neurology. May 1997;48(5):1204-11. [Medline].

  20. Post-stroke Rehabilitation Guideline Panel. Post-stroke Rehabilitation. Gaithersburg, Md: Aspen Pub; 1996.

  21. Rabinstein AA. Case 5-2004: a man with slurred speech and left hemiparesis. N Engl J Med. May 20 2004;350(21):2213-4; author reply 2213-4. [Medline].

  22. Zweifler RM. Management of acute stroke. South Med J. Apr 2003;96:380-5. [Medline].

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Further Reading

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Keywords

lacunar stroke, lacunar infarct, lacunar infarction, lacune, ischemic stroke, small-vessel disease, hemiparesis, ataxic hemiparesis, dysarthria, clumsy hand, motor stroke, sensory stroke, sensorimotor stroke, hypertension, diabetes mellitus, embolism, cardioembolism, artery-to-artery embolism

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Contributor Information and Disclosures

Author

Adam B Agranoff, MD, Physiatrist and Partner, Chelsea Back Care, Chelsea Community Hospital
Adam B Agranoff, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and North American Spine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Edward H Wong, MB, BCh, Stroke Fellow, Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario
Edward H Wong, MB, BCh is a member of the following medical societies: American Academy of Neurology and American Heart Association
Disclosure: Nothing to disclose.

Medical Editor

Robert J Kaplan, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Kansas School of Medicine and Medical Center
Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, International Spine Intervention Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard Salcido, MD, Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine
Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St. Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers, Phoenix
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching

 
 
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