Pure motor hemiparesis and sensorimotor stroke: Accuracy of very early clinical diagnosis of lacunar strokes

Danilo Toni, Rita Del Duca, Marco Fiorelli, Maria Luisa Sacchetti, Stefano Bastianello, Franco Giubilei, Claudio Martinazzo, Corrado Argentino

Research output: Contribution to journalArticlepeer-review


Background and Purpose Clinical differentiation of lacunar from nonlacunar strokes in the very early phase could help to exclude patients with lacunar stroke from pharmacologic trials designed for nonlacunar strokes, namely, those with thrombolytic agents. In a continuous series of acute ischemic stroke patients, we evaluated how accurately a clinical diagnosis of pure motor hemiparesis or sensorimotor stroke formulated in the first hours from onset predicts a lacunar stroke documented by cerebral computed tomography or by autopsy. Methods We examined 517 patients (299 men, 218 women; mean±SD age, 67±10 years) within 12 hours (mean±SD, 6.1±3.2 hours) of the event. At hospital admission, we observed 151 (29%) patients with pure motor hemiparesis and 68 (13%) patients with sensorimotor stroke. Results Computed tomography or autopsy was compatible with a lacunar stroke (ie, detection of a lacune or permanently negative computed tomography) in 170 (33%) patients, of whom 123 (72%) had pure motor hemiparesis and 47 (28%) had sensorimotor stroke. This led to a sensitivity of 72%, a specificity of 72%, a positive predictive value of 56%, and a negative predictive value of 84%. Overall positive predictive value of pure motor hemiparesis was 58% (60% for two areas and 58% for three areas involved), and that of sensorimotor stroke was 51% (87% for two areas and 40% for three areas involved). By separately evaluating the sides of lesions, we found a positive predictive value of 46% for right-side infarcts and of 72% for left-side infarcts. Right-side lesions constituted 51% of lesions in lacunar syndrome patients with lacunar stroke, 76% in those with nonlacunar stroke, 19% in nonlacunar syndrome patients with lacunar stroke, and 31% in those with nonlacunar stroke (P

Original languageEnglish
Pages (from-to)92-96
Number of pages5
Issue number1
Publication statusPublished - 1994


  • Cerebral ischemia
  • Diagnostic imagery
  • Lacunar infarction
  • Pure motor stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialised Nursing
  • Neuroscience(all)


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