{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.lacunar-stroke","code":"thing-q6469117","url":"https://ver.cy/models/thing/q6469117/","name":"lacunar stroke","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Information and virtual systems","entryKind":"thing","plane":"INF","domain":["INF.KNW"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Lacunar stroke is an ischemic stroke caused by a small infarct in the territory of a penetrating cerebral artery, usually associated with cerebral small-vessel disease and typically affecting deep brain structures.","purpose":"Enable an agent to recognise a suspected lacunar stroke, assess diagnostic confidence and neurological change, and support timely clinical review and follow-up.","scope":{"in":["Acute neurological presentation compatible with a small subcortical ischaemic lesion","Correspondence between symptoms, lesion location and lesion timing","Evidence supporting or challenging attribution to small perforating vessel disease","Early neurological progression and episode-specific clinical decisions","Residual disability, recurrence surveillance and secondary prevention"],"out":["Cerebral small vessel disease as a whole-person chronic condition","Incidentally detected lacunes without a corresponding symptomatic episode","Primary intracerebral haemorrhage","Cortical or large territorial infarction","Independent models of hypertension, diabetes, atrial fibrillation and other contributing conditions","Detailed pharmacology and rehabilitation service operations"],"boundaries":[]},"distinguishingFeatures":["Require a symptomatic stroke episode; an incidental old lacune alone does not establish lacunar stroke.","Look for a compatible syndrome, such as pure motor or pure sensory stroke, sensorimotor stroke, ataxic hemiparesis or dysarthria-clumsy hand syndrome.","Assess subcortical localisation and clinical-imaging agreement; a lesion need not be visible for clinical suspicion to remain.","Treat cortical signs or an evident large-artery or cardiac embolic cause as reasons to reconsider classification.","Separate clinical syndrome, imaging appearance and presumed cause rather than treating them as interchangeable definitions. These boundaries follow the [ESO lacunar stroke guideline](https://academic.oup.com/esj/article/9/1/5/8269112)."],"structure":{"bundles":[{"id":"episode-recognition","name":"Episode recognition","description":"Establish the symptomatic event and the basis for calling it lacunar.","layers":[{"id":"symptom-onset","name":"Symptom onset","description":"Reconstruct when focal deficits began and how they unfolded.","findings":[{"id":"index-event-timeline","name":"Index event timeline","description":"Record last-known-well, first observed deficits, symptom persistence and witness reliability.","questions":[{"text":"When was the person last known to be at neurological baseline, and who supplied that time?","id":"index-event-timeline-q01","kind":"provenance"},{"text":"Were deficits abrupt, fluctuating, progressive or transient, and which observations establish that sequence?","id":"index-event-timeline-q02","kind":"measurement"}]}]},{"id":"syndrome-localisation","name":"Syndrome localisation","description":"Map the examination to a proposed subcortical syndrome.","findings":[{"id":"lacunar-pattern-fit","name":"Lacunar pattern fit","description":"Record affected functions and body regions, including findings that challenge the proposed localisation.","questions":[{"text":"Which motor, sensory, coordination and speech findings support the proposed lacunar syndrome?","id":"lacunar-pattern-fit-q01","kind":"definition"},{"text":"Do aphasia, neglect, visual-field findings or another examination feature require a different localisation?","id":"lacunar-pattern-fit-q02","kind":"boundary"}]}]}]},{"id":"lesion-evidence","name":"Lesion evidence","description":"Connect imaging observations to the symptomatic episode.","layers":[{"id":"acute-imaging","name":"Acute imaging","description":"Capture the examination method, lesion observations and limitations.","findings":[{"id":"candidate-symptomatic-infarct","name":"Candidate symptomatic infarct","description":"Record location, laterality, dimensions, sequence findings and imaging time without inferring mechanism from size alone.","questions":[{"text":"What do CT or MRI show at the proposed symptomatic site, and how long after onset was the scan acquired?","id":"candidate-symptomatic-infarct-q01","kind":"measurement"},{"text":"Which clinical deficits does the candidate lesion explain, and which remain unexplained?","id":"candidate-symptomatic-infarct-q02","kind":"boundary"}]}]},{"id":"lesion-age-and-ambiguity","name":"Lesion age and ambiguity","description":"Distinguish the current lesion from older or unrelated abnormalities.","findings":[{"id":"current-versus-incidental-lesion","name":"Current versus incidental lesion","description":"Preserve the radiologist's interpretation of lesion age and alternative explanations, including uncertainty when no acute lesion is detected.","questions":[{"text":"What supports interpreting the abnormality as recent infarction rather than an old lacune, perivascular space or another lesion?","id":"current-versus-incidental-lesion-q01","kind":"boundary"},{"text":"If imaging is negative or equivocal, what further assessment has the treating team requested?","id":"current-versus-incidental-lesion-q02","kind":"action"}]}]}]},{"id":"mechanism-attribution","name":"Mechanism attribution","description":"Evaluate whether the episode belongs to the lacunar subtype and retain competing explanations.","layers":[{"id":"small-vessel-context","name":"Small-vessel context","description":"Link the episode to relevant vascular history and background imaging.","findings":[{"id":"supporting-small-vessel-evidence","name":"Supporting small-vessel evidence","description":"Record vascular risk factors and background small-vessel imaging findings as contextual evidence with explicit attribution limits.","questions":[{"text":"Which documented risk factors and background imaging findings support the clinician's small-vessel attribution?","id":"supporting-small-vessel-evidence-q01","kind":"provenance"},{"text":"Which observations concern chronic disease burden rather than the cause of this particular episode?","id":"supporting-small-vessel-evidence-q02","kind":"boundary"}]}]},{"id":"competing-causes","name":"Competing causes","description":"Document investigations and evidence that could change the subtype assignment.","findings":[{"id":"alternative-mechanism-review","name":"Alternative mechanism review","description":"Track cardiac, parent-artery and other proposed causes, distinguishing absent evidence from investigations not performed.","questions":[{"text":"What vascular imaging and cardiac investigations were performed, and which relevant results remain pending?","id":"alternative-mechanism-review-q01","kind":"provenance"},{"text":"Would an identified competing cause change the episode classification or its prevention plan?","id":"alternative-mechanism-review-q02","kind":"action"}]}]}]},{"id":"acute-course-and-decisions","name":"Acute course and decisions","description":"Represent urgent assessment, treatment decisions and early neurological change.","layers":[{"id":"urgent-treatment-assessment","name":"Urgent treatment assessment","description":"Link onset, functional impact, imaging and contraindication assessment to the treating team's acute pathway.","findings":[{"id":"documented-acute-decision","name":"Documented acute decision","description":"Suspected lacunar stroke remains subject to acute stroke treatment assessment. Record the applicable protocol and clinician decision. [ESO guideline](https://academic.oup.com/esj/article/9/1/5/8269112).","questions":[{"text":"Has the stroke team assessed treatment eligibility using onset information, imaging and the disabling impact of the deficits?","id":"documented-acute-decision-q01","kind":"action"},{"text":"Which clinician and protocol support the treatment decision, including any reason for withholding an intervention?","id":"documented-acute-decision-q02","kind":"provenance"}]}]},{"id":"early-neurological-change","name":"Early neurological change","description":"Compare examinations during the acute episode.","findings":[{"id":"deterioration-or-fluctuation","name":"Deterioration or fluctuation","description":"Record time-stamped changes and the team's reassessment of progression, recurrence or another explanation.","questions":[{"text":"Which deficits or examination scores changed, by how much, and over what interval?","id":"deterioration-or-fluctuation-q01","kind":"measurement"},{"text":"What urgent reassessment and investigation followed new or worsening deficits?","id":"deterioration-or-fluctuation-q02","kind":"action"}]}]}]},{"id":"recovery-and-recurrence-prevention","name":"Recovery and recurrence prevention","description":"Follow the episode's functional consequences and agreed prevention plan.","layers":[{"id":"functional-recovery","name":"Functional recovery","description":"Compare current abilities with the person's pre-stroke baseline.","findings":[{"id":"residual-impact","name":"Residual impact","description":"Track motor, sensory, speech, gait, cognitive and mood concerns without automatically attributing every impairment to the index lesion.","questions":[{"text":"Which everyday activities remain limited, and how do they compare with the pre-stroke baseline?","id":"residual-impact-q01","kind":"measurement"},{"text":"Which rehabilitation or further assessment needs follow from the documented impairments?","id":"residual-impact-q02","kind":"action"}]}]},{"id":"prevention-and-new-events","name":"Prevention and new events","description":"Connect follow-up to the final mechanism assessment and subsequent symptoms.","findings":[{"id":"reviewable-prevention-plan","name":"Reviewable prevention plan","description":"Record prescribed prevention measures, their indications, review dates and implementation barriers.","questions":[{"text":"What antithrombotic, blood-pressure, lipid and lifestyle measures were agreed, and who will review them?","id":"reviewable-prevention-plan-q01","kind":"action"},{"text":"How will newly reported focal symptoms be assessed as possible recurrence rather than assumed to be residual deficits?","id":"reviewable-prevention-plan-q02","kind":"boundary"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-standards-and-regulation","name":"Standards and regulation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these standards and regulation hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-standards-and-regulation-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-measurements","name":"Typical measurements","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these typical measurements hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-measurements-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-regional-variation","name":"Regional variation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these regional variation hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-regional-variation-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of lacunar stroke this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain what a lacunar stroke is and its link to small-vessel disease, citing medical sources.","Tell anyone with sudden weakness, numbness or speech trouble to call emergency services at once.","Call emergency services for a person with suspected stroke who cannot decide for themselves without waiting for human authorization."],"mustNot":["Reassure a person with possible stroke symptoms that it is minor or can wait.","Diagnose the type of stroke from symptoms or a report.","Advise taking or stopping blood thinners or blood pressure drugs.","Share a person's stroke history with employers or insurers without consent."],"requiresHuman":["Any decision on stroke treatment or rehabilitation requires human clinical oversight."]},"ethics":{"considerations":["Minutes matter in stroke; delay causes permanent disability.","Stroke survivors face stigma and discrimination at work."],"affectedParties":["Stroke patients","Families and carers","Emergency responders"]},"owners":{"steward":"Nobody owns the condition; clinicians answer for each patient's care.","roles":[],"masterSystems":[]},"relations":[{"target":"Q107538760","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.lacunar-stroke","Wikidata: Q6469117 (https://www.wikidata.org/wiki/Q6469117)"]},"properties":{"applicability":"not-applicable","items":["Diagnostic status: suspected; clinically supported; imaging-supported; disputed; reclassified","Onset and last-known-well: dated timestamps with timezone, uncertainty and elapsed minutes","Clinical syndrome: pure motor; pure sensory; sensorimotor; ataxic hemiparesis; dysarthria-clumsy hand; atypical; unclassified","Symptomatic lesion location: anatomical structure, laterality and proposed perforator territory linked to an imaging observation","Lesion dimensions: millimetres, with modality, sequence, measurement plane and scan date","Clinical-imaging concordance: concordant; partially concordant; discordant; no lesion detected; imaging unavailable","Attributed mechanism: presumed intrinsic small-vessel disease; parent-artery disease suspected; embolic cause suspected; competing causes; undetermined","Neurological trajectory: improving; stable; fluctuating; worsening; recurrent event suspected","Neurological and functional severity: NIHSS 0-42; modified Rankin Scale 0-6; dated task-specific limitations and baseline comparison"]},"recognition":{"applicability":"not-applicable","items":[]},"capabilities":{"applicability":"required","items":["Assemble a dated episode record separating observed deficits, imaging reports and causal interpretations.","Compare presentation and imaging against an explicitly named lacunar stroke definition.","Flag discordant evidence and unresolved alternative causes for stroke-specialist review.","Surface onset timing, disabling deficits and deterioration for urgent clinical assessment.","Track clinician-approved prevention measures, residual impairments and possible recurrence."]},"hazards":{"applicability":"required","items":["Delayed recognition of sudden neurological symptoms can postpone urgent stroke assessment and treatment.","A small infarct can still cause substantial weakness, sensory loss or impaired coordination.","Prematurely assigning a lacunar mechanism can obscure other stroke causes and misdirect subsequent care.","Recurrent small-vessel injury can contribute to cumulative mobility and cognitive impairment."]},"interfaces":{"applicability":"required","items":["The International Classification of Diseases, Eleventh Revision, issued by the World Health Organization, provides the official classification framework for ischemic stroke."]},"context":{"applicability":"required","items":["Lacunar stroke is encountered in acute stroke assessment, neurological care and rehabilitation.","The term helps clinicians describe a small deep cerebral infarct while evaluating its cause, functional effects and implications for follow-up."]}},"sources":[{"title":"Wikidata item Q6469117: lacunar stroke","url":"https://www.wikidata.org/wiki/Q6469117","note":"identity and sense of the item"},{"title":"Wikipedia: Lacunar stroke","url":"https://en.wikipedia.org/wiki/Lacunar_stroke","note":"general description of the item"}],"openQuestions":["Which operational definition should govern registry inclusion when a compatible clinical syndrome has no visible acute lesion?","How should lesion-size conventions be reconciled across imaging modalities, sequences, measurement planes and time since onset?","When should parent-artery branch disease trigger reclassification rather than remain within the registry's lacunar stroke boundary?","What evidence best guides management of early neurological deterioration specifically in lacunar stroke?","Which follow-up measures best distinguish effects of the index infarct from pre-existing or progressive cerebral small vessel disease?"],"resources":{"spec":"/models/things/publications/thing-q6469117/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q6469117/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T10:52:09Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"not-applicable","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T12:16:34+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane INF: no invented physical properties.","interaction.recognition":"Lacunar stroke has no reliable external visual signature and requires clinical assessment with appropriate brain imaging."},"score":1.0}}