Lacunar Infract - Oren Zarif - Lacunar Infarct

The white matter hyperintensities and lacunar infarct are hallmarks of cerebral small vessel disease. While most lacunar infarcts are clinically silent, some may have associated clinical symptoms. The etiology of lacunar infarcts is dependent on their anatomical location. Those that occur in deep white matter are often clinically silent, appearing in confluent WMHs. Depending on their location, they may be caused by chronic ischemia, arteriolosclerosis, or endots.

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Although the prevalence of CSVD and other causes of stroke remain low, several other risk factors may contribute to the development of a lacunar infarct. Smoking, high cholesterol levels, and BMI were not associated with increased risk of this complication. Patients with diabetes and hypertension may be more susceptible than those without these risk factors. While these factors do increase the risk of developing lacunar infarct, they do not appear to have any particular risk factor.

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Treatment for lacunar stroke depends on the symptoms and the time it takes to relieve the blockage. If treatment is delayed, more brain cells are damaged. Therefore, it is imperative to get to a hospital setting within three hours after the symptoms have appeared. For this reason, dual antiplatelet therapy is highly recommended. Patients who had previously received TPA should delay starting dual antiplatelet therapy for 24 hours after symptoms have occurred.

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Large subcortical infarcts were classified as large lacunar infarcts, but their size was not related to their focus of restricted diffusion on DWI. The defects of CTP appear as regional abnormalities larger than the location of lacunar stroke. While the authors of this study did not set a threshold, there is some disagreement. Furthermore, a focus of restricted diffusion may represent an "core" of the infarct, while an abnormality may be a wider zone of ischemia.

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The definition of a lacunar infarct is relatively simple. The condition refers to the occlusion of a small, penetrating artery. There are many possible causes, including microatheroma, embolism, or lipohyalinosis. It may also be the result of cerebral autosomic dominant arteriopathy. When it occurs in a small vessel, it is called a lacunar infarct.

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In addition to the risk of another stroke, it is important to identify any underlying cause of a lacunar infarct. An understanding of the underlying mechanisms of lacunar ischaemic stroke may lead to more effective secondary prevention strategies. Further studies are necessary to determine the pattern of brain lesions. Once identified, an effective treatment regimen can be designed. The treatment for lacunar infarction is largely determined by the underlying cause of the infarct.

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The most sensitive technique for detecting a lacunar infarct is CTP. A study of 1085 CTP examinations conducted within 12 hours of the onset of stroke symptoms reviewed the ability of CTP to detect lacunae. The researchers noted a statistically significant difference between the two imaging techniques. The CTP method showed greater specificity than CTA in detecting lacunar infarcts in the basal ganglia, thalamus, and CSWM, respectively.

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Researchers have noted that new lacunar infarcts have a distinct relationship with the progression of WMH. This association can be seen with the presence of asymmetric WMH. Asymmetry in the WMH may increase the risk of lacunar infarcts. Nevertheless, patients with severe WMH may develop a new vascular infarct. For this reason, the risk of recurrent lacunar infarcts is greater in individuals with higher WMH burden.

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The symptoms of a lacunar infarct are different from those of a large vessel ischemic stroke. Large artery ischemia is distinguished from lacunar infarct by the presence of cortical symptoms. Neuroimaging modalities are also useful in distinguishing between them. Seizures are caused by excessive neuronal activity. Tonic-clonic activity and the postictal state after a seizure differentiate the two conditions. Complications of migraine often include headache and an aura. A typical aura may include sensory symptoms. MRI reveals the presence of brain tumors.