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Lacunar Stroke: Relationship Between Atypical Etiology and Infarct Size?

Lacunar Stroke: Relationship Between Atypical Etiology and Infarct Size? Abstract To the Editor. —A number of recent publications1-3 have emphasized that small deep cerebral infarcts can be caused by a variety of etiologic factors including cardioembolism and large vessel occlusion. This has led some authors to conclude that the "lacune hypothesis," which suggests that lacunes are caused by lesions involving small perforating brain arteries, is a "fallacy"1 and that the term lacunar "should be evicted from the bedside."2In their recent article,4 Waterston and colleagues provide further evidence that the cause of small deep cerebral infarcts is diverse. In reviewing their study, as well as other reports of patients with lacunes of "atypical etiology,"5 it appears that a high percentage of these patients have unusually large lacunes.Most lacunes are only 2 to 3 mm in maximal diameter,6,7 and Fisher7 believed that lacunes greater than 10 mm in diameter should be designated as giant References 1. Millikan C, Futrell N. The fallacy of the lacune hypothesis . Stroke . 1990;21:1251-1257.Crossref 2. Landau WM. Au clair de lacune: holy, wholly, holey logic . Neurology . 1989;39:725-730.Crossref 3. Angeloni U, Bozzao L, Fantozzi L, Bastianello S, Kushner M, Fieschi C. Internal borderzone infarction following acute middle cerebral artery occlusion . Neurology . 1990;40:1196-1198.Crossref 4. Waterston JA, Brown MM, Butler P, Swash M. Small deep cerebral infarcts associated with occlusive internal carotid artery disease: a hemodynamic phenomenon? Arch Neurol . 1990;47:953-957.Crossref 5. Cerebral Embolism Task Force. Cardiogenic brain embolism . Arch Neurol . 1989;46:727-743.Crossref 6. Mohr JP. Progress in cerebrovascular disease: lacunes . Stroke . 1982;13:3-10.Crossref 7. Fisher CM. Lacunes: small deep cerebral infarcts . Neurology . 1965;15:774-784.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Lacunar Stroke: Relationship Between Atypical Etiology and Infarct Size?

Archives of Neurology , Volume 48 (12) – Dec 1, 1991

Lacunar Stroke: Relationship Between Atypical Etiology and Infarct Size?

Abstract

Abstract To the Editor. —A number of recent publications1-3 have emphasized that small deep cerebral infarcts can be caused by a variety of etiologic factors including cardioembolism and large vessel occlusion. This has led some authors to conclude that the "lacune hypothesis," which suggests that lacunes are caused by lesions involving small perforating brain arteries, is a "fallacy"1 and that the term lacunar "should be evicted from the bedside."2In their...
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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1991.00530240017005
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. —A number of recent publications1-3 have emphasized that small deep cerebral infarcts can be caused by a variety of etiologic factors including cardioembolism and large vessel occlusion. This has led some authors to conclude that the "lacune hypothesis," which suggests that lacunes are caused by lesions involving small perforating brain arteries, is a "fallacy"1 and that the term lacunar "should be evicted from the bedside."2In their recent article,4 Waterston and colleagues provide further evidence that the cause of small deep cerebral infarcts is diverse. In reviewing their study, as well as other reports of patients with lacunes of "atypical etiology,"5 it appears that a high percentage of these patients have unusually large lacunes.Most lacunes are only 2 to 3 mm in maximal diameter,6,7 and Fisher7 believed that lacunes greater than 10 mm in diameter should be designated as giant References 1. Millikan C, Futrell N. The fallacy of the lacune hypothesis . Stroke . 1990;21:1251-1257.Crossref 2. Landau WM. Au clair de lacune: holy, wholly, holey logic . Neurology . 1989;39:725-730.Crossref 3. Angeloni U, Bozzao L, Fantozzi L, Bastianello S, Kushner M, Fieschi C. Internal borderzone infarction following acute middle cerebral artery occlusion . Neurology . 1990;40:1196-1198.Crossref 4. Waterston JA, Brown MM, Butler P, Swash M. Small deep cerebral infarcts associated with occlusive internal carotid artery disease: a hemodynamic phenomenon? Arch Neurol . 1990;47:953-957.Crossref 5. Cerebral Embolism Task Force. Cardiogenic brain embolism . Arch Neurol . 1989;46:727-743.Crossref 6. Mohr JP. Progress in cerebrovascular disease: lacunes . Stroke . 1982;13:3-10.Crossref 7. Fisher CM. Lacunes: small deep cerebral infarcts . Neurology . 1965;15:774-784.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Dec 1, 1991

References