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  • Writer's pictureOren Zarif

CTP Is Superior to NCCT/CTA for Identifying Lacunar Infarcts - Oren Zarif - Lacunar Infarct

CTP has been shown to be superior to NCCT/CTA for identifying lacunar infarcts, according to a recent study. The researchers reviewed 1085 CTP examinations of patients who had suffered an acute stroke and had a subsequent MRI or DWI within seven days of the initial symptomatic episode. The investigators defined lacunar infarcts as those greater than 2 cm in diameter, based on NIHSS scores.

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While there are several risk factors associated with this type of stroke, only one study examined the association between baseline vascular risk factors and new infarcts. The authors hypothesized that this type of stroke was associated with an increased risk of basal ganglia-related stroke. The study also found a strong association between age and history of cerebrovascular disease. In addition, patients with a higher baseline white matter hyperintensity volume are more likely to experience a new lacunar infract.

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While lacunar infracts usually produce restricted neurological signs, they do not cause monoparesis. Despite the lack of pathological confirmation and lack of clinical details, these lesions should be considered by clinicians when patients exhibit a monoparesis. The diagnosis of lacunar infracts can help prevent larger infarcts from developing. These patients are also more likely to respond to antiplatelet therapy than other stroke patients.

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One study reported that acute lacunar infarcts are more likely to occur in patients with WMH, and those with asymmetric WMH are more susceptible to the disease. The authors also reported that higher WMH burden was associated with subsequent lacunar stroke. It is important to note that asymmetric WMH may also be an independent risk factor for developing lacunar infarcts. The findings from this study support this notion.

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The main parts of the cerebral circulation comprise the arterial system, which forms a 'Willis' circle. There are main branches of the arterial system, including the anterior cerebral artery, the posterior cerebral artery, and the basilar artery. Deeper branches of the brain supply deep white and gray matter. A lacunar infarct is smaller than 10 mm in diameter and is caused by occlusion of a small penetrating artery.

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Because the lacunar infract is more common in young adults, the underlying mechanism that contributes to cognitive decline is unclear. However, this mechanism may be the same for other forms of stroke, which is why the TOAST method is often recommended. Although the underlying mechanism may be different, a TOAST study may still help to target effective secondary prevention measures for lacunar infract. Further studies are needed to determine the exact pattern of brain lesion in lacunar stroke.

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Patients with a lacunar infract are often characterized by a classical lacunar syndrome. This syndrome may include dysarthria, pure motor hemiparesis, ataxic hemiparesis, or a combination of these. It is not uncommon for patients to present with monoparesis, although the latter is rare. A diagnosis of thrombotic lacunar infarction is often a good one for patients with this condition.

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While T1-weighted images can identify the presence of a lacunar infarct, they are inferior to FLAIR or T2-weighted MRI. The diffusion-weighted image has the highest diagnostic accuracy for lacunar infarct, and can differentiate between acute and chronic infarctions. The lacunes are characterized by focal areas of decreased signal intensity in T1 and T2-weighted images, whereas the chronic lesions are characterized by isointensity to CSF.

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The severity of the symptoms and course of treatment of a lacunar infract depends on the specific region of the brain affected. The right brain hemisphere controls sensation and motor function on the left side of the body. On the other hand, the left brain hemisphere controls motor function on the right side. Consequently, a lesion in one region of the brain may have effects on the opposite side of the body.

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Several supportive measures are used to stabilize a patient's condition. Physiotherapy is used to help restore lost abilities. Supportive measures include medications to assist the heart and respiratory functions. Patients can also be given anticoagulant medication directly at the site of the blockage in the brain. Aspirin is often administered within 48 hours to prevent clotting. Patients may also undergo rehabilitation through physiotherapy. The treatment for a lacunar infract is similar to that of an ischemic stroke.

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A lacunar infract is relatively common. It is a result of a lack of blood flow in small arteries. Because of its smaller size, lacunar infarcts are often asymptomatic. However, a single or multiple lacunar infract may lead to severe cognitive and physical disabilities. If not treated properly, the stroke can lead to more severe complications, including cognitive and behavioral impairment.

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