Lacunar Infract - Oren Zarif - Lacunar Infarct

The mechanism of lacunar infarct is controversial. Some speculate that lacunes are caused by emboli from the heart or larger arteries. However, cross-sectional observational studies do not help to establish causality. Furthermore, these studies focus on symptomatic patients, and a higher percentage of lacunes may be silent. As such, a more complete understanding of the pathophysiology of lacunes may only be gained through larger prospective studies.

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Age, smoking, diabetes mellitus, and hypertension are known risk factors. Previous strokes are also associated with an increased risk of lacunar stroke. People with high blood pressure or heart conditions are also at a higher risk. Additionally, individuals with high cholesterol or obstructive sleep apnea are at greater risk of developing lacunar stroke. Fortunately, patients recover from these strokes. However, the long-term effects of lacunar infarct may include cognitive deficits, white matter disease, and subcortical dementia.

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Symptomatic treatment of lacunar infarct may include supportive measures to assist the patient's breathing and heart functions. Anticoagulant medications may be given intravenously or orally to prevent the formation of blood clots. Depending on the severity of the symptoms, patients may require additional treatments. Rehabilitation services can help them overcome their limitations and return to normal activities. Some patients may experience a decline in their ability to control their emotions.

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Neuroimaging studies of people with first-time lacunar stroke have revealed a rare form of silent multiple lacunar infarction. The MRIs of patients with these infarctions showed mild neuropsychological changes, including a reduction in executive functions and short delayed verbal memory. This type of stroke is associated with several characteristics, including leukoaraiosis, perivascular hyperintensities, and ischemia.

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Patients with a suspected lacunar infarct should undergo a carotid ultrasound to detect any signs of atherosclerotic narrowing of the extracranial carotid artery. Those patients with severe carotid stenosis are at increased risk of stroke. If the lesions are more than 70 percent, neuroimaging imaging should be performed to identify the lesion. Moreover, a complicated migraine is usually accompanied by an aura, with sensory symptoms.

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Symptoms of lacunar stroke depend on which part of the brain is damaged. Different regions of the brain control different aspects of the body. The left hemisphere controls the motor functions and sensation on the left side of the body, whereas the right hemisphere is responsible for sensation on the right side of the body. Hence, a lesion in one part of the brain will affect the opposite side.

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Moreover, the TOAST method, which relies on risk factors for developing stroke, tends to be biased. Consequently, patients with lacunar strokes have higher chances of developing it, despite the occurrence of several risk factors. But, further work is necessary to understand the patterns and the mechanism of lacunar infarct. Once we understand the mechanisms of lacunar stroke, we can develop effective secondary prevention strategies.

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The findings of the NCCT/CTA study are consistent with those of other studies. It shows that CTP is specific for lacunar infarct, and it does not correlate with the focus of restricted diffusion on DWI. The defects on CTP appear on the DWI as regional abnormalities, even if they are larger than the location of lacunar stroke. Likewise, in the previous study, Rudilosso et al. (15) noted that CTP can detect infarcts up to 2 cm, but did not report any CTP thresholds. As such, the study cannot conclude conclusively whether CTP is accurate in diagnosing lacunar infarct.

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NCCT/CTA are inferior to CTP in detecting lacunar infarcts. However, CTP was more specific than DWI, which failed to detect lacunar strokes in the basal ganglia and thalamus. Therefore, patients with this type of stroke should undergo both tests to get the best diagnosis. The CTP/CTA may not be as useful as NCCT in detecting lacunar infarcts, but it can help doctors to identify if they have a stroke.

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A lacunar infarct is a type of stroke in which an artery supplying blood to the brain becomes blocked. These small arteries are branch off a large, high-pressure artery. The infarct occurs within the deepest parts of the brain, and has a high risk of developing another stroke in the future. The best way to reduce the damage caused by a lacunar infarct is to diagnose it as early as possible.

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Although there are many factors associated with a risk for lacunes, age and sex were the strongest associations between a patient's age and a risk of a lacune. Ankle-to-arm ratio and a higher creatinine level were both strongly related to the risk of a lacune. Furthermore, people with stenosis of 50% or more in their internal carotid artery at baseline were more likely to develop lacunes.