{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T10:52:09Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 26.0, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a0953d-d7b0-7091-89fd-4b2763b35721\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: lacunar stroke\nSense to describe: (none recorded)\nDomain code: XCT.STA\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 044: 1001 ", "usd": 0.0, "recall": true }, "codex": { "seconds": 77.1, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a0953d-d73b-7fe0-bbca-b75e1a51e39c\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: lacunar stroke\nRegistry id: vr.tr.lacunar-stroke\nPlane / domain: XCT / XCT.STA\nRegistry definition: (none recorded)\nNames folded into this entry: (no" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:39:52+00:00", "fields": [ "agent_conduct", "ethics", "owners" ] }, "revisions": [ { "at": "2026-10-07T11:37:45+00:00", "engine": "codex", "fields": [ "agent_conduct" ], "answering_review": "e699c509c678c6bc4b71f2a08cd2f9421fc21cb8f06ae6e557efa8a148d4bce5" } ], "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T12:16:34+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q6469117", "registryId": "vr.tr.lacunar-stroke", "name": "lacunar stroke", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "XCT.STA" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q6469117/", "model": { "registry_id": "vr.tr.lacunar-stroke", "name": "lacunar stroke", "purpose": "Enable an agent to recognise a suspected lacunar stroke, assess diagnostic confidence and neurological change, and support timely clinical review and follow-up.", "definition": "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.", "scope_statement": "This model owns the symptomatic lacunar stroke episode registered as vr.tr.lacunar-stroke in XCT / XCT.STA, including its clinical localisation, supporting imaging, attributed mechanism, evolution and care decisions; it distinguishes the episode from underlying cerebral small vessel disease.", "in_scope": [ "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_of_scope": [ "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" ], "distinguishing_features": [ "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)." ], "characteristics": [ { "name": "Diagnostic status", "kind": "state", "unit_or_values": "suspected; clinically supported; imaging-supported; disputed; reclassified", "why_it_matters": "Makes confidence explicit and permits revision as investigations return." }, { "name": "Onset and last-known-well", "kind": "measurement", "unit_or_values": "dated timestamps with timezone, uncertainty and elapsed minutes", "why_it_matters": "Connects the episode to urgent assessment and treatment eligibility." }, { "name": "Clinical syndrome", "kind": "category", "unit_or_values": "pure motor; pure sensory; sensorimotor; ataxic hemiparesis; dysarthria-clumsy hand; atypical; unclassified", "why_it_matters": "Records the observed presentation independently of the inferred mechanism." }, { "name": "Symptomatic lesion location", "kind": "relation", "unit_or_values": "anatomical structure, laterality and proposed perforator territory linked to an imaging observation", "why_it_matters": "Allows comparison between lesion location and the distribution of deficits." }, { "name": "Lesion dimensions", "kind": "measurement", "unit_or_values": "millimetres, with modality, sequence, measurement plane and scan date", "why_it_matters": "Supports classification without using an unexplained size threshold as proof." }, { "name": "Clinical-imaging concordance", "kind": "category", "unit_or_values": "concordant; partially concordant; discordant; no lesion detected; imaging unavailable", "why_it_matters": "Prevents an unrelated old lesion from being assigned to the current symptoms." }, { "name": "Attributed mechanism", "kind": "category", "unit_or_values": "presumed intrinsic small-vessel disease; parent-artery disease suspected; embolic cause suspected; competing causes; undetermined", "why_it_matters": "Keeps causal attribution reviewable and records reasons for reclassification." }, { "name": "Neurological trajectory", "kind": "state", "unit_or_values": "improving; stable; fluctuating; worsening; recurrent event suspected", "why_it_matters": "Supports comparison of serial examinations and escalation when deficits change." }, { "name": "Neurological and functional severity", "kind": "measurement", "unit_or_values": "NIHSS 0-42; modified Rankin Scale 0-6; dated task-specific limitations and baseline comparison", "why_it_matters": "Separates examination scores from consequences for the person's activities." } ], "affordances": [ "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." ], "agent_conduct": { "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." ], "must_not": [ "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." ], "requires_human": [ "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." ], "affected_parties": [ "Stroke patients", "Families and carers", "Emergency responders" ] }, "owners": { "steward": "Nobody owns the condition; clinicians answer for each patient's care.", "master_systems": [] }, "what_it_is_for": [ "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." ], "standards_and_regulation": [ "The International Classification of Diseases, Eleventh Revision, issued by the World Health Organization, provides the official classification framework for ischemic stroke." ], "failure_modes_and_hazards": [ "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." ], "facets_not_applicable": { "recognition": "Lacunar stroke has no reliable external visual signature and requires clinical assessment with appropriate brain imaging." } }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q6469117: lacunar stroke", "url": "https://www.wikidata.org/wiki/Q6469117", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Lacunar stroke", "url": "https://en.wikipedia.org/wiki/Lacunar_stroke", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "episode-recognition", "name": "Episode recognition", "description": "Establish the symptomatic event and the basis for calling it lacunar.", "rationale": "The registry entry needs an episode boundary that does not confuse a clinical stroke with an incidental imaging finding.", "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?", "kind": "provenance", "id": "index-event-timeline-q01" }, { "text": "Were deficits abrupt, fluctuating, progressive or transient, and which observations establish that sequence?", "kind": "measurement", "id": "index-event-timeline-q02" } ] } ] }, { "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?", "kind": "definition", "id": "lacunar-pattern-fit-q01" }, { "text": "Do aphasia, neglect, visual-field findings or another examination feature require a different localisation?", "kind": "boundary", "id": "lacunar-pattern-fit-q02" } ] } ] } ] }, { "id": "lesion-evidence", "name": "Lesion evidence", "description": "Connect imaging observations to the symptomatic episode.", "rationale": "A small subcortical abnormality needs temporal and anatomical interpretation before it can support this diagnosis.", "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?", "kind": "measurement", "id": "candidate-symptomatic-infarct-q01" }, { "text": "Which clinical deficits does the candidate lesion explain, and which remain unexplained?", "kind": "boundary", "id": "candidate-symptomatic-infarct-q02" } ] } ] }, { "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?", "kind": "boundary", "id": "current-versus-incidental-lesion-q01" }, { "text": "If imaging is negative or equivocal, what further assessment has the treating team requested?", "kind": "action", "id": "current-versus-incidental-lesion-q02" } ] } ] } ] }, { "id": "mechanism-attribution", "name": "Mechanism attribution", "description": "Evaluate whether the episode belongs to the lacunar subtype and retain competing explanations.", "rationale": "The model must distinguish a plausible small-vessel mechanism from the mere presence of a small infarct.", "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?", "kind": "provenance", "id": "supporting-small-vessel-evidence-q01" }, { "text": "Which observations concern chronic disease burden rather than the cause of this particular episode?", "kind": "boundary", "id": "supporting-small-vessel-evidence-q02" } ] } ] }, { "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?", "kind": "provenance", "id": "alternative-mechanism-review-q01" }, { "text": "Would an identified competing cause change the episode classification or its prevention plan?", "kind": "action", "id": "alternative-mechanism-review-q02" } ] } ] } ] }, { "id": "acute-course-and-decisions", "name": "Acute course and decisions", "description": "Represent urgent assessment, treatment decisions and early neurological change.", "rationale": "An agent must not let a presumed lacunar label substitute for evaluating the current stroke presentation.", "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?", "kind": "action", "id": "documented-acute-decision-q01" }, { "text": "Which clinician and protocol support the treatment decision, including any reason for withholding an intervention?", "kind": "provenance", "id": "documented-acute-decision-q02" } ] } ] }, { "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?", "kind": "measurement", "id": "deterioration-or-fluctuation-q01" }, { "text": "What urgent reassessment and investigation followed new or worsening deficits?", "kind": "action", "id": "deterioration-or-fluctuation-q02" } ] } ] } ] }, { "id": "recovery-and-recurrence-prevention", "name": "Recovery and recurrence prevention", "description": "Follow the episode's functional consequences and agreed prevention plan.", "rationale": "The model needs to judge recovery beyond lesion size and retain responsibility for follow-up decisions.", "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?", "kind": "measurement", "id": "residual-impact-q01" }, { "text": "Which rehabilitation or further assessment needs follow from the documented impairments?", "kind": "action", "id": "residual-impact-q02" } ] } ] }, { "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?", "kind": "action", "id": "reviewable-prevention-plan-q01" }, { "text": "How will newly reported focal symptoms be assessed as possible recurrence rather than assumed to be residual deficits?", "kind": "boundary", "id": "reviewable-prevention-plan-q02" } ] } ] } ] }, { "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.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "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.", "evidence": [ "This is a recall-based description; no sources were consulted.", "The listed kinds are classic clinical syndromes, not mutually exclusive pathological subtypes or definitive evidence of mechanism.", "Size thresholds depend on imaging modality, lesion age and terminology; researchers should verify the applicable definitions and coding version." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of lacunar stroke this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Pure motor lacunar syndrome", "Pure sensory lacunar syndrome", "Sensorimotor lacunar syndrome", "Ataxic hemiparesis", "Dysarthria-clumsy hand syndrome" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of lacunar stroke this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "ICD-10, World Health Organization", "value_or_pattern": "I63.-", "note": "Cerebral infarction category; exact coding depends on the documented mechanism and national modification, and this category is not specific to lacunar stroke." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of lacunar stroke this model covers, and on what evidence?", "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.", "evidence": [ "STRIVE neuroimaging terminology and reporting recommendations, developed by an international expert collaboration, distinguish recent small subcortical infarcts from lacunes of presumed vascular origin.", "American Heart Association/American Stroke Association guidelines address acute ischemic stroke management and secondary prevention." ], "questions": [ { "id": "evidence-standards-and-regulation-q01", "text": "Which of these standards and regulation hold for the sense of lacunar stroke this model covers, and on what evidence?", "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.", "evidence": [ "Clinical classification of patients presenting with characteristic motor, sensory, coordination or speech deficits.", "Interpretation of brain MRI to identify a small deep infarct and assess accompanying small-vessel disease.", "Etiologic investigation that considers small-vessel disease alongside embolic and parent-artery causes.", "Planning secondary prevention, rehabilitation and follow-up after ischemic stroke." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of lacunar stroke this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "Maximum diameter of a recent small subcortical infarct on axial imaging", "typical_range": "Usually less than 20; this imaging convention alone does not establish the mechanism", "unit": "mm" }, { "quantity": "Diameter of a chronic lacune of presumed vascular origin", "typical_range": "Approximately 3-15; a lacune is a cavity and does not necessarily document a prior symptomatic lacunar stroke", "unit": "mm" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of lacunar stroke this model covers, and on what evidence?", "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.", "evidence": [ "Persistent weakness, sensory impairment, dysarthria or impaired coordination despite the small lesion size.", "Early neurological deterioration after initially mild or fluctuating symptoms.", "Recurrent stroke and cumulative disability.", "Cognitive impairment and gait dysfunction associated with accumulating small-vessel injury.", "Diagnostic misclassification: a lacunar syndrome or small deep infarct does not by itself prove intrinsic small-vessel disease." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of lacunar stroke this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-regional-variation", "name": "Regional variation", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "National ICD modifications and local coding practices differ.", "MRI availability affects detection and distinction from other causes of small deep brain lesions." ], "questions": [ { "id": "evidence-regional-variation-q01", "text": "Which of these regional variation hold for the sense of lacunar stroke this model covers, and on what evidence?", "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.", "evidence": [ { "name": "Cerebral small-vessel disease", "difference": "A broader group of vascular disorders that can produce lacunar stroke, white-matter injury, microbleeds and other abnormalities." }, { "name": "Lacune of presumed vascular origin", "difference": "A chronic fluid-filled imaging cavity, whereas lacunar stroke denotes a clinical ischemic event." }, { "name": "Lacunar syndrome", "difference": "A pattern of neurological deficits that can arise from causes other than a lacunar infarct." }, { "name": "Cortical ischemic stroke", "difference": "Involves cerebral cortex and may produce cortical signs such as aphasia or neglect, which are generally absent in classic lacunar syndromes." }, { "name": "Branch atheromatous disease", "difference": "Atheroma affecting the origin of a penetrating artery can cause a deep infarct resembling lacunar stroke; distinguishing it requires assessment of lesion pattern and arterial disease." } ], "questions": [ { "id": "evidence-neighbours-q01", "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?", "kind": "provenance" } ] } ] } ] } ] }, "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?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 19, "questions": 29 } }