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  • Writer's pictureOren Zarif

Lacunar Infarct and Stroke - Oren Zarif - Lacunar Infarct

A new MRI study demonstrates a high prevalence of lacunar infarct in healthy older adults. While it is impossible to know if a lacunar infarct is responsible for the symptoms observed in the study subjects, it is important to know whether the occurrence of a lacunar infarct on MRI is related to an increased risk for stroke in the later stages of life. This study was based on data from the Cardiovascular Health Study (CHS) and involved 3660 subjects.

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The STRIVE criteria were used to define lacunar infarcts. These lesions were characterized by a subcortical location, a diameter of three to fifteen millimeters, and an infarct involving deep white matter (WMH). The sensitivity of DWI for lacunar infarcts was excellent and increased by 50% compared to CTP. However, the specificity of CTP was 97.4%, while that of CBF was 98%.

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The frequency of recurrent ischemic stroke after a lacunar infarct is lower than that of small infarcts, a complication of atrial fibrillation. The frequency of small infarcts in ischemic stroke is similar to that in the general population over 60 years of age and higher in very old patients. In addition to age, smoking, obesity, and physical inactivity are associated with increased risk for stroke.

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The risk of new lacunar infarct is significantly higher in patients with a history of cerebrovascular disease, and asymmetric white matter hyperintensity volume. In addition, age and sex are significant risk factors. The risk of new lacunar infarct increases after adjusting for age, hypertension, and use of antihypertensive medications. This increase in the risk of new lacunar infarct was also associated with a patient's age, gender, and baseline white matter hyperintensity volume.

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The causes of lacunes are unclear. Some experts believe that emboli from other vessels or the heart may cause lacunes. Studies conducted in this area have not been able to establish a direct causal link between these two conditions, though some have attempted to do so. Although this theory is not yet proven, lacunes are still considered a complication of cerebral autosomic dominant arteriopathy, but it is a possibility that can lead to a stroke in patients without any evidence of heart disease.

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The second most common lacunar syndrome is ataxic hemiparesis, which affects the leg more than the arm. It is also known as homolateral ataxia and is characterized by a period of hours. A sensory stroke, meanwhile, affects the midbrain and causes a numbness and tingling sensation in the affected limb. It is rare for such a stroke to lead to monoparesis.

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Patients with a lacunar infarct will need to be evaluated by a neurologist and receive treatment from a multidisciplinary team. Rehabilitation services are also essential and may involve physical, occupational, and speech therapy. A primary care provider should monitor the patient's medications for possible drug interactions and to prescribe appropriate rehabilitation therapy. Patients should also monitor their risk factors for stroke and adhere to antithrombotic agents.

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Researchers have studied SVD and the neurology of capsular genu infarction. Their findings have been reported in J Neurol Neurosurg Psychiatry. In particular, researchers from China have investigated cognitive progression and the effects of SVD on cognitive outcomes after lacunar infarction. In addition, SVD also has a significant impact on the severity of strokes in Chinese patients.

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The sensitivity of CTP in detecting lacunar infarct is low and its specificity is high. The highest sensitivity was achieved by CSWM combined with TTP, followed by PVWM with TTP. However, CTP did not detect infarcts in the basal ganglia. In contrast, NCCT/CTA showed a 99.7% sensitivity rate. The thalamus and basal ganglia were rarely affected by lacunar infarct.

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