lacunar stroke

Index event timeline

Record last-known-well, first observed deficits, symptom persistence and witness reliability.

1. When was the person last known to be at neurological baseline, and who supplied that time? provenance
2. Were deficits abrupt, fluctuating, progressive or transient, and which observations establish that sequence? measurement

Lacunar pattern fit

Record affected functions and body regions, including findings that challenge the proposed localisation.

1. Which motor, sensory, coordination and speech findings support the proposed lacunar syndrome? definition
2. Do aphasia, neglect, visual-field findings or another examination feature require a different localisation? boundary

Candidate symptomatic infarct

Record location, laterality, dimensions, sequence findings and imaging time without inferring mechanism from size alone.

1. What do CT or MRI show at the proposed symptomatic site, and how long after onset was the scan acquired? measurement
2. Which clinical deficits does the candidate lesion explain, and which remain unexplained? boundary

Current versus incidental lesion

Preserve the radiologist's interpretation of lesion age and alternative explanations, including uncertainty when no acute lesion is detected.

1. What supports interpreting the abnormality as recent infarction rather than an old lacune, perivascular space or another lesion? boundary
2. If imaging is negative or equivocal, what further assessment has the treating team requested? action

Supporting small-vessel evidence

Record vascular risk factors and background small-vessel imaging findings as contextual evidence with explicit attribution limits.

1. Which documented risk factors and background imaging findings support the clinician's small-vessel attribution? provenance
2. Which observations concern chronic disease burden rather than the cause of this particular episode? boundary

Alternative mechanism review

Track cardiac, parent-artery and other proposed causes, distinguishing absent evidence from investigations not performed.

1. What vascular imaging and cardiac investigations were performed, and which relevant results remain pending? provenance
2. Would an identified competing cause change the episode classification or its prevention plan? action

Documented acute decision

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).

1. Has the stroke team assessed treatment eligibility using onset information, imaging and the disabling impact of the deficits? action
2. Which clinician and protocol support the treatment decision, including any reason for withholding an intervention? provenance

Deterioration or fluctuation

Record time-stamped changes and the team's reassessment of progression, recurrence or another explanation.

1. Which deficits or examination scores changed, by how much, and over what interval? measurement
2. What urgent reassessment and investigation followed new or worsening deficits? action

Residual impact

Track motor, sensory, speech, gait, cognitive and mood concerns without automatically attributing every impairment to the index lesion.

1. Which everyday activities remain limited, and how do they compare with the pre-stroke baseline? measurement
2. Which rehabilitation or further assessment needs follow from the documented impairments? action

Reviewable prevention plan

Record prescribed prevention measures, their indications, review dates and implementation barriers.

1. What antithrombotic, blood-pressure, lipid and lifestyle measures were agreed, and who will review them? action
2. How will newly reported focal symptoms be assessed as possible recurrence rather than assumed to be residual deficits? boundary

Check these first

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these check these first hold for the sense of lacunar stroke this model covers, and on what evidence? provenance

Kinds and varieties

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these kinds and varieties hold for the sense of lacunar stroke this model covers, and on what evidence? provenance

Identifiers and schemes

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these identifiers and schemes hold for the sense of lacunar stroke this model covers, and on what evidence? provenance

Standards and regulation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these standards and regulation hold for the sense of lacunar stroke this model covers, and on what evidence? provenance

Real-world use

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these real-world use hold for the sense of lacunar stroke this model covers, and on what evidence? provenance

Typical measurements

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these typical measurements hold for the sense of lacunar stroke this model covers, and on what evidence? provenance

Failure modes and hazards

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these failure modes and hazards hold for the sense of lacunar stroke this model covers, and on what evidence? provenance

Regional variation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these regional variation hold for the sense of lacunar stroke this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Recalled without web access and unsourced; every item is a lead to verify.

1. 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? provenance