Neuroimaging Evidence of a Lacunar Infract - Oren Zarif - Lacunar Infarct

The presence of a lacunar infract on CTP does not correlate with the presence of a focal restricted diffusion in DWI. Defects on CTP appear as regional abnormalities and are typically larger than the site of a lacunar infract. A previous study by Rudilosso et al. (15) noted focal defects on CTP, but did not establish a threshold. The abnormalities may represent the "core" of an infarct rather than the wider area of ischemia.

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Recent Small Subcortical Infarcts are neuroimaging evidence of an infarct. Usually 20 mm in diameter in the axial plane, they are associated with lacunar stroke syndrome. Diffusion-weighted images show lacunes as fluid-filled cavities of presumed vascular origin. Lacunes are consistent with a previous RSSI and a hemorrhage within the territory of a perforating artery.

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MRI scans reveal an infarct in the cerebrum of first-time lacunar stroke patients. These patients show mild neuropsychological abnormalities, including impaired executive functions and short delayed verbal memory. They also present symptoms of seizures and hydrocephalus. This finding indicates the presence of a lacunar infract, which is a rare but critical type of stroke. And since it's difficult to distinguish between lacunar and other types of infracts, future studies should focus on the cognitive symptoms of patients with this type of infract.

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Another study showed that acute lacunar infarcts are more likely to occur in the cerebral hemisphere containing more severe WMH. These patients also have increased rates of other types of stroke, including asymmetric WMH. And while the association between WMH and lacunar infarction is unclear, there is evidence that it does not imply that the development of asymptomatic WMH is a risk factor for subsequent lacunar infracts.

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The diagnosis of a lacunar infract is often difficult because it's difficult to distinguish between a lacunar infract and a stroke caused by a large vessel. In addition, the symptoms of lacunar stroke depend on the region of the brain that is affected. For example, the right hemisphere controls motor functions and sensation on the left side of the body while the left hemisphere is responsible for the right-side sensation. Therefore, a lesion in one part of the brain may affect the opposite side.

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The majority of cases of lacunar infract are pure motor hemiparesis. In addition to hemiparesis, patients may also have dysarthria. If left untreated, these strokes can lead to a much larger infarct. Regardless of its cause, patients with these strokes need to be monitored closely for signs of this condition. This way, these small infarcts can be identified early, and may prevent a large infarct.

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In addition to microatheroma involving the lenticulostriate branch, a lacunar infract can be caused by deep penetrating artery occlusion. A macroatheroma caused by parent artery occlusion is another cause. There is debate about whether vascular dementia is caused by repeated episodes of lacunar infarction. There are five distinct syndromes associated with lacunar infract.

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This study also examined risk factors for new lacunar infracts in the deep white matter. Twenty-four patients with new infracts had baseline vascular risk factors different from those with a previously existing lacunar infarct. Further, there were differences in the risk factor profiles of patients with lacunar infracts in the basal ganglia. In conclusion, new infarcts in the deep white matter differ from those in the basal ganglia.

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While NCCT/CTA are better at detecting lacunar infarcts, CTP does not show the same accuracy. The study included 1085 CTP examinations performed in patients with acute stroke symptoms. The patients underwent CTP and MRI within 12 hours of the stroke and had a lacunar infarct of at least 2 cm. The infarcts were then recorded based on the NIHSS (National Institute of Health and Safety Studies) score.