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From the Department of Cerebrovascular Disease (Drs. Nakamura and Saku), Institute of Neuroscience, St. Mary’s Hospital, Kurume; and Second Department of Internal Medicine (Drs. Ibayashi and Fujishima), Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Address correspondence and reprint requests to Dr. Kensei Nakamura, Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
OBJECTIVE: To study the clinical characteristics of the progression of motor deficits in lacunar stroke patients.
BACKGROUND: Some patients with lacunar infarction have progression of their neurologic deficits, but it is not known which patients will progress or why they progress.
METHODS: The authors evaluated 92 consecutive patients (47 men, 45 women; age, 69.4 ± 10.9 years [mean ± SD]) with first-ever stroke due to supratentorial lacunes in the internal capsule or the corona radiata. By defining lacunar infarction in which motor deficits progressed between admission and the day after admission as progressive lacunar infarction, the authors compared progressive lacunar infarction with stable lacunar infarction.
RESULTS: Of 92 patients, 25 (27%) had progression of deficits. Diabetes mellitus (p = 0.02) and severity of motor deficit on admission (p = 0.006) were related independently to progression in a logistic multiple regression analysis. Size of the infarct was slightly larger (1.2 ± 0.4 cm2 versus 0.9 ± 0.5 cm2; p = 0.01) and functional status at discharge was worse (median Barthel index, 45 versus 100; p < 0.001) in patients with progressive infarction than in those without progression. There were no significant differences between the two groups regarding the site of the infarct or blood pressure or hematocrit levels on or after admission.
CONCLUSIONS: The progression of motor deficits is associated with a relatively poor functional outcome. Diabetes mellitus and the severity of motor deficit on admission may predict progression of motor deficits.
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