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Clinical Implications of Headache in Lacunar Stroke: Relevance of Site of Infarct

CME

Authors

  • Adrià Arboix MD, PhD,

  • Marta Grau-Olivares MD,

  • Luis García-Eroles MD,

  • Joan Massons MD,

  • Emili Comes MD,

  • Cecilia Targa MD


  • For CME, visit http://www.headachejournal.org

  • From the Cerebrovascular Division, Department of Neurology, University of Barcelona, Hospital del Sagrat Cor, Universitat of Barcelona, Spain (Drs. Arboix, Grau-Olivares, Massons, Comes, Targa); and Clinical Information Systems, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain (Dr. García-Eroles).

Address all correspondence to Dr. Adrià Arboix, Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Viladomat 288, E-08029 Barcelona, Spain.

Abstract

Objective.—To assess whether the infarction topography influenced upon the incidence of headache and the likelihood of neurological recovery in lacunar infarction.

Background.—The relationship between topography of infarction and the incidence of headache as well as the influence of headache on neurological outcome in patients with lacunar stroke are still unclear.

Methods.—In a cohort of 387 patients with neuroimaging-proven acute lacunar infarction collected from a prospective hospital-based stroke registry over a 12-year period, 43 patients (11.1%) presented with headache within a 72-hour interval of stroke onset.

Results.—Headache was more common in deep brain gray matter or brainstem lacunar infarction than in supratentorial white matter lacunar infarction (14.9% vs 8%, P < .033), but lacunar infarctions in the supratentorial white matter had less frequently absence of limitation at discharge (15.1% vs 25.1%, P < .013). In deep brain gray matter or brainstem lacunar infarction, early neurological recovery decreased from 26.2% to 19.2% when headache was present at stroke onset. In the multivariate analysis, dysarthria-clumsy hand and absence of headache in deep brain gray matter or brainstem lacunar infarction were independent predictors of favorable outcome.

Conclusions.—In patients with lacunar infarction, headache at stroke onset was more common in deep brain gray matter or brainstem topographies than in supratentorial white matter lesions. In deep brain gray matter or brainstem lacunar infarctions, early neurological recovery was less likely when headache was present.

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