Lacunar Infract - Oren Zarif - Lacunar Infarct

A lacunar infarct is a small, deep infarct of the brain stem or deep white matter. In the past, lacunar infarcts were viewed as benign vascular lesions with favorable long-term outcomes. But, newer research shows that lacunar infarcts are associated with increased risk of dementia and cognitive decline. These findings also highlight the role of age, vascular risk factors, and high nocturnal blood pressure in the development of the condition.

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The causes of lacunar infarcts have not yet been established. Regardless of their causes, both MRIs and clinical examinations have the potential to diagnose this condition. Several factors have been linked to a higher risk for this condition, including atrial fibrillation, low physical activity, smoking, and diabetes. The risk of developing a lacunar infarct in one of these groups is similar to that of the general population over sixty years, although it is higher in elderly patients.

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The clinical and radiological features of a lacunar infarct are distinctive. The characteristic occlusion of a single penetrating branch may lead to a lacunar infarct, while a macroatheroma may result from occlusion of the parent artery. Microatheroma and embolism may also contribute to lacunar infarct. In addition to embolism, other causes of lacunar infarct include infections and vasculitis. Other causes may include vasospasm, although this cannot be confirmed on autopsy. Lastly, atherosclerosis of the small cerebral arteries is responsible for subcortical ischemia.

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The STRIVE criteria define lacunar infarct as an infarct of the deep white matter of the brain. The study population includes patients with multiple lacunar infarcts as well as single infarcts. One study reported a significantly higher incidence of multiple lacunar infarcts in young patients. Moreover, it is important to remember that a lacunar infarct is a sign of a larger underlying problem that should be addressed.

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In the Cardiovascular Health Study (CHS), more than 3660 subjects were studied. Of those, 1131 had ischemic infarcts while 841 had lacunes. Most of these older individuals denied any history of stroke. MRI-defined lacunes can have no symptoms or be undetectable in a stroke. This could be a sign of a different disease, which needs further study.

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In the deep white matter, lacunar infarcts may be associated with risk factors that affect the vascular system. Patients with high vascular risk are at increased risk for a stroke in these areas. The deep white matter is a watershed area that receives cerebral blood from deep perforating arteries. Arteriolosclerosis can reduce cerebral blood flow and cause impaired autoregulation. This disease is also associated with a weakened blood-brain barrier.

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CTP has been shown to be superior to NCCT/CTA for the detection of lacunar infarcts, according to a recent study. In this study, 1085 CTP examinations were reviewed. Patients who had symptoms of acute stroke had their CTP within 12 hours of the start of their stroke. The study concluded that 85% of patients had an infarct in their brain, as defined by NIHSS scores.

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Cognitive impairment is a common side effect of lacunar infarction, and cognitive functioning is often impaired. Studies on the cognitive effects of lacunar infarction have been positive in recent years. This study also showed a significant association between lacunar infarction and white matter lesions, suggesting that the condition has a causal role. The study also shows that the disease itself has vascular consequences, as it is the most common cause of dementia.

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In addition to improving overall survival, patients with a lacunar stroke who suffer from a single silent lacunar lesion tend to have a better prognosis than those with multiple, silent lesions. Furthermore, the findings indicate that two distinct types of lacunar stroke exist. Despite the fact that the latter is associated with a poorer overall functional outcome, patients with more than one silent lacunar lesion have a higher risk of death.