Infarctul Lacunar in Patologia Vasculara Cerebrala

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INFARCTUL LACUNAR N PATOLOGIA VASCULAR CEREBRAL ISCHEMIC C. MUTU, M. PEREANU, ALINA ALEXE Secia clinic de Neurologie, Spitalul Clinic Judeean Sibiu Motivaie: Infarctul lacunar (lacun ischemic unic cu diametrul ntre 2 i 15 mm) i lacunarismul cerebral (dou sau mai multe lacune) reprezint un procent important din totalul accidentelor vasculare cerebrale ischemice avnd o semnificaie clinic i evolutiv aparte. Obiectiv: Evaluarea clinic, imagistic i evolutiv a pacienilor cu ictus lacunar internai n Clinica de Neurologie Sibiu. Metod: Studiul retrospectiv a 154 de pacieni (81 brbai i 73 femei) cu diagnostiul de infarct cerebral lacunar sau lacunarism cerebral internai n Clinica de Neurologie Sibiu n perioada 1.01.2005-31.12.2005. Datele au fost culese prin analiza foilor de observaie ale pacienilor. Rezultate: Din totalul de 303 pacieni cu stoke ischemic, 69 pacieni (22%) au prezentat infarct lacunar unic i 73 pacieni (24%) lacunarism cerebral. Incidena maxim a aprut n decada a 8-a (35,7%) urmat de decada a 7-a (32,45%) de vrst. Principalii factori de risc au fost: hipertensiunea arterial la 109 pacieni (71%), bolile cardiace ischemice la 66 pacieni (43%), stroke n antecedente la 42 pacieni (28%), diabetul zaharat la 29 pacieni (19%), dislipidemia la 28 pacieni (18,2%), obezitatea la 17 pacieni (11%) i fibrilaia atrial cronic la 14 pacieni (9%). La examenul clinic 82 pacieni (53%) au prezentat hemiparez motorie pur, 29 pacieni (19%) atac senzitiv pur, 23 pacieni (15%) hemiparez cu afazie motorie, 10 pacieni (6%) hemiparez ataxic, 7 pacieni (5%) sindrom lacunar atipic i 3 pacieni (2%) dizartrie cu mn nesigur. Evoluia a fost favorabil la 96% dintre pacieni, staionar la 2 %, agravat i respectiv deces la 1% dintre pacieni. Concluzii: Aproape un sfert (22%) dintre pacieni au prezentat un infarct lacunar, un alt sfert (24%) prezentnd lacunarism cerebral. Hemipareza motorie pur a fost principalul simptom prezent urmat de atacul senzitiv pur i hemipareza cu afazie motorie.

LACUNAR STROKE IN VASCULAR ISCHEMIC CEREBRAL PATHOLOGY C. MUTU, M. PEREANU, ALINA ALEXE Clinical Department of Neurology, Clinical County Hospital of Sibiu Background: Lacunar infarct (small deep infarct with diameter within 2-15 mm) and multiple lacunar infarcts (two or more lacunae) represent an important percent of the total number of vascular cerebral attacks having a special clinical and evolutional significance. Objective: Clinical, imagistic and evolutional evaluation of patients suffering a lacunar stroke who were admitted in Clinical Department of Neurology. Method: This was a retrospective study made on 154 patients (of which 87 were male and 73 female) diagnosed with lacunar stroke (single or multiple) and being hospitalized during 01.01.2005-31.12.2005 interval. The data were picked up from the information recorded in the clinic papers. Results: From a total number of 303 patients which presented ischemic stroke, 69 (22%) patients presented a single lacunar infarct and 73 (24%) patients - multiple lacunar infarcts. Maximal incidence occurred in the eighth decade (35,7%), followed by the seventh decade (32,45%). The main risk factors were: arterial hypertension at 109 (71%) patients, ischemic heart diseases at 66 (43%) patients, stroke in case history at 42 (28%) patients, diabetes mellitus at 29 (19%) patients, dyslipidemia at 28 (18,2%) patients, obesity at 17 (11%) patients and chronic atrial fibrilation at 14 (9%) patients. 82 (53%) patients presented pure motor hemiparesis at clinical examination, 29 (19%) patients presented pure sensory stroke, 23 (15%) patients presented hemiparesis with motor aphasia, 10 (6%) patients presented ataxic hemiparesis, 7 (5%) patients atypical lacunar syndromes and 3 patients - dysarthria and clumsy hand. At 96% of patients the evolution was favorable, stationary at 2% of them and aggravated respectively deadly at 1%. Conclusions: Almost a quarter (22%) of patients presented a single lacunar infarct and another quarter (24%) of them presented multiple lacunar infarcts. Pure motor hemiparesis was the main symptom occurred, being followed by pure sensory stroke and hemiparesis with motor aphasia.