Four recurrent intracerebral haemorrhages

Differing risk factors and outcomes in ischemic stroke subtypes: focus on lacunar stroke

Lacunar stroke has been a recognized stroke subtype for many years but its pathophysiology remains unknown, so prevention and treatment are suboptimal. Most lacunar strokes result from an intrinsic cerebral small vessel disease, probably part of a systemic disorder. Hypertension, diabetes and other vascular risk factors (but not atrial fibrillation and ipsilateral carotid stenosis) are equally common in lacunar as in large artery atherothromboembolic stroke, which, together with other factors, suggests that the patient’s response to vascular risk factors, not the vascular risk factors per se, determines whether they develop small vessel or large artery stroke. Inflammation and endothelial failure are probably involved in the pathogenesis of lacunar stroke, but their role needs to be clarified. The cerebral venules as well as arterioles are abnormal in this condition. The disorder may not be primarily ischemic; instead, arteriolar thrombosis may be a late-stage phenomenon secondary to chronic arteriolar wall damage resulting from leakage of plasma components across the BBB. Accurate diagnosis of lacunar stroke, avoiding risk factor-based classifications, is required to underpin future research.

Stroke in Italy: A Disease to Prevent

Stroke, a disease determining an increasing socioeconomic burden in aging populations, represents the second cause of mortality worldwide and the third cause of mortality in western countries. In our study, crude annual incidence rate of stroke was 293/ 100,000. Several conditions and life-style factors have been identified as risk factors for stroke. Their recognition is important to prevent stroke. Atherothrombosis contributes a large proportion of cases; however, conventional stroke risk factors do not fully account for the risk of stroke, and often stroke victims with documented atherosclerosis may not show any conventional risk factor. A major goal is to promote prevention of stroke through identification and clarification of new risk factors and pathogenic mechanisms. Moreover, early stroke prevention requires a comprehensive multidisciplinary strategy to educate and promote adherence to preventive protocols.