Prevalence and predictive factors of progression in pure motor, ataxic hemiparesis and mixed sensorimotor lacunar syndrome

Objectives: To explore the prevalence and predictive factors of progressive lacunar stroke (PLS).Methods: Consecutive patients with acute lacunar stroke, who were admitted at King Chulalongkorn Memorial hospital during 1st July 2015-30th June 2018, were retrospectively recruited. The clinical lacunar stroke was defined as acute motor deficit lasting more than 24 hours and clinical syndrome compatible with pure motor hemiparesis, ataxic hemiparesis or sensorimotor stroke. The patients with cardioembolism or imaging shown cortical involvement was excluded. PLS was considered if there was an increase in NIHSS more than 2 points during admission. Patient characteristics, clinical data, imaging findings and medical treatment during admission was statistically analyzed. Functional outcome was assessed based on the modified Rankin Scale at discharge and 3 months. Results: Of 302 patients, 70 (23.2%) had PLS. Multivariate logistic regression analysis revealed that age at stroke onset more than 60 years (adjusted odd ratio [aOR], 2.17; 95% confidence interval [CI], 1.16-4.06, p=0.016), initial systolic blood pressure (SBP) more than 165 mmHg (aOR 2.40, 95%CI 1.25-4.61, p=0.008), white blood cell (WBC) more than 8500/ microliters (aOR 1.95, 95%CI 1.05-3.62, p=0.034), pontine infarction (aOR 1.99, 95%CI 1.07-3.71, p=0.031), branch atheromatous disease (BAD) (aOR 2.47, 95%CI 1.37-4.48, p=0.003), and significant vessels stenosis relevant to infarction (aOR 2.41, 95%CI 1.09-5.36, p=0.031) were independent predictors of PLS.Conclusion: Age more than 60 years, initial SBP more than 165mmHg, WBC more than 8500/microliters, pontine infarction, BAD and significant symptomatic artery stenosis are associated with PLS.