Lacunar Stroke - Oren Zarif - Lacunar

A lacunar stroke is a type of stroke that involves damage to the deep brain organs known as lacunes. These organs are responsible for relaying communications between the cortex and brainstem and for coordinating complicated body movements. Because the lacune is small in size, a stroke from this type can be devastating, leading to significant disability. Lacunar strokes account for about 20 percent of strokes in the United States.

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The first descriptions of the lacune were written in the late nineteenth and early twentieth centuries. Imaging technology later confirmed the first hypothesis. Today, the term is used to describe a small, chronic cavity in the brain that represents a lacunar infarction. It can also be the result of an intracerebral hemorrhage. While the cause of lacunar stroke remains unclear, it is generally associated with the presence of high-blood-pressure or hypertension, or an increased risk of cardiovascular disease.

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Infarcts from the white matter in the brain are considered a hallmark of cerebral small vessel disease, although they may be silent or produce clinical symptoms. The underlying cause is unknown, although genetic factors may increase the risk. Some vascular disorders, such as APOE e4 alleles, increase the risk of white matter lesions. Cerebral autosomal dominant arteriopathy, or CADIA, is another potential risk factor.

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A pure motor lacunar stroke results in damage to the motor and sensory areas of the brain. Damage to these areas causes a loss of voluntary movement, such as tremor. Motor abnormalities, meanwhile, result in muscle weakness in the affected side. The face is rarely affected in a lacunar stroke. The resulting paralysis can be severe and cause permanent disability. The patient's symptoms can vary, but are often mild.

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Antiplatelet therapy is the most common treatment for patients with a lacunar stroke. This treatment option includes antiplatelet therapy and treatment of vascular risk factors, including hypertension and hyperlipidemia. During treatment, the patient may receive therapy up to six times a day to improve their ability to carry out daily activities. Ultimately, a lacunar stroke will lead to some level of permanent brain damage and impairment, but recovery is possible.

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A lacunar stroke occurs when an artery that branches into the deep brain is blocked. These arteries are small and branch directly off of the large main artery. This artery is highly muscular and carries high blood pressure. While the stroke may be small, multiple lacunar infarctions can result in a substantial amount of disability. When multiple lacunar infarctions occur, the brain is left with only a small amount of oxygen.

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A lacunar infarct may be the result of a deep penetrating branch occlusion, microatheroma involving a lenticulostriate branch, or macroatheroma caused by occlusion of the parent artery. Other causes of a lacunar infarct include vasculitis, infection, and embolism. Autopsy cannot determine if a vasospasm is the cause of the infarct. However, atherosclerosis of small cerebral arteries is one of the most common underlying causes of ischemic stroke.

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Patients with a lacunar syndrome often have other neurological problems in addition to the infarct. Non-lacunar infarts are typically more extensive than lacunes and are more likely to lead to a sudden onset of stroke symptoms. Acute lacunar infarcts caused by cardioembolism are uncommon, accounting for only 2.6 to 5% of all strokes. However, one case of a patient with a lacunar infarct was due to macroembolism.

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Although the study was a single case study, it was a cross-sectional observational study that found a significant relationship between age and risk of lacunes. Age and sex were associated with a higher risk of lacunes. In addition, having an MRI of the internal carotid artery was associated with greater stenosis. In the same way, women were more likely to have lacunes than men.