Can we stop the stuttering in stroke? Interventions in 40 patients with acute lacunes

Published:April 12, 2019DOI:https://doi.org/10.1016/j.jns.2019.04.009

      Highlights

      • Stuttering lacunar syndromes are infrequent.
      • Their complex clinical features and pathophysiology defy a uniform treatment.
      • Intravenous alteplase is the choice of treatment within 4.5-h window.
      • A loading dose of aspirin-clopidogrel may be an option when alteplase is not.
      • Blood pressure augmentation may benefit some patients with labile blood pressure.

      Abstract

      Background

      Whether any treatment can stop fluctuations of stuttering lacunar syndromes (SLS) is unclear. Case reports have variably suggested effectiveness of intravenous thrombolysis, dual antiplatelet treatment, blood pressure augmentation and anticoagulation. We aim to describe our experience with different treatments used in in patients presenting with SLS and their effect on clinical fluctuations and functional outcome.

      Methods

      We collected demographic and clinical data of consecutive adult patients with SLS. Descriptive summaries were reported as median and inter-quartile range (IQR) for continuous variables and as frequencies and percentages for categorical variables.

      Results

      Forty patients (72 ± 10 years, 36% female) were included. Pure motor syndrome (57%) was the most frequent clinical presentation. Clinical fluctuations stopped and the improvement was temporally related to aspirin-clopidogrel in 11/17 cases, intravenous thrombolysis in 4/6 cases, blood pressure augmentation in 1/3 cases and aspirin in 1/7 cases. Two patients continued fluctuating after IVT and later responded to blood pressure augmentation (n = 1) or aspirin-clopidogrel (n = 1).

      Conclusions

      Aspirin plus clopidogrel may be followed by clinical improvement when intravenous thrombolysis is not an option. Blood pressure augmentation may beneficial as ad-on treatment in patients with labile blood pressure.

      Keywords

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