Progressive lacunar stroke: review of mechanisms, prognostic features, and putative treatments

Int J Stroke. 2012 Jun;7(4):321-9. doi: 10.1111/j.1747-4949.2012.00789.x. Epub 2012 Mar 30.


Lacunar stroke is generally considered to have a fair outcome. However 20-30% of patients with lacunar stroke worsen neurologically in hours or days after onset, reaching eventually an unexpectedly severe disability status. In the field of acute stroke, progressive lacunar stroke remains an important unresolved practice problem, because as yet no treatment does exist proven to prevent or halt progression. Pathophysiology of progression is yet incompletely understood. Hemodynamic factors, extension of thrombosis, excitotoxicity, and inflammation, have been proposed as possible mechanisms of progression. A few clinical studies also aimed at establishing presentation features that may help identifying patients at risk of deterioration. In this paper, we review hypothesized mechanisms of lacunar stroke progression and possible markers of early deterioration. Moreover, based on putative mechanisms and suggestions from reported evidence, we propose a few treatments that seem worthy to be tested by randomized clinical trials.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Blood Pressure
  • Brain Edema / complications
  • Cerebral Infarction / complications
  • Disease Progression
  • Encephalitis / complications
  • Glutamic Acid / physiology
  • Hemodynamics / physiology
  • Humans
  • Magnesium Sulfate / therapeutic use
  • Neuroprotective Agents / therapeutic use
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prognosis
  • Stroke, Lacunar / drug therapy
  • Stroke, Lacunar / etiology*
  • Stroke, Lacunar / physiopathology
  • Thrombolytic Therapy / methods
  • gamma-Aminobutyric Acid / physiology


  • Anticoagulants
  • Neuroprotective Agents
  • Platelet Aggregation Inhibitors
  • Glutamic Acid
  • gamma-Aminobutyric Acid
  • Magnesium Sulfate