Lacunar Infarct in the Basal Ganglia - Oren Zarif - Lacunar Infarct
The diagnosis of lacunar infarct is not always straightforward. This is because lacunar strokes are very small and are not well-represented on a CT scan. A more accurate imaging test is magnetic resonance imaging (MRI), which can reveal lacunar infarcts. Another imaging test is CT angiography, which can show blood vessel blockages and help doctors diagnose lacunes. Although the study design is imperfect, it provides some useful information.
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While the exact cause of lacunar infarcts is not known, people with a history of stroke may be at greater risk. Annual physical examinations can detect any health problems that may increase a person's risk. If high cholesterol or obstructive sleep apnea is suspected, medical attention must be sought right away. Patients should be treated as quickly as possible, as a stroke could have disastrous effects on their heart and blood vessels.
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A new lacunar infarct in the basal ganglia is not a progressive variant of small vessel disease. It is likely that the condition is a symptom of a more serious underlying disease. However, this new finding should not be dismissed lightly. As with other small vessel diseases, new lacunar infarcts should be evaluated closely and properly managed. Once they are diagnosed, patients may experience personality changes or dementia.
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The findings of this study suggest that MRI-defined lacunar infarcts are not rare among elderly people. While age, diastolic blood pressure, and creatinine level are risk factors, the differences between the subgroups are not significant enough to suggest a different mechanism of disease. Furthermore, subjects with silent lacunes are at increased risk of stroke and cognitive dysfunction. Further research is needed to determine if these lacunes are useful indicators of subsequent risk of stroke.
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The cause of a lacunar infarct is unknown but it involves a deep penetrating branch occlusion, a micro atheroma involving the lenticulostriate branch, or a macroatheroma caused by occlusion of the parent artery. Atherosclerosis of the small cerebral arteries is also a risk factor. Hence, if you suspect a lacunar infarct in an adult, it is better to be safe than sorry.
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In a multivariable analysis of the data of the two studies, a higher percentage of patients with deep white matter infarcts developed a new case. Furthermore, patients with new infarcts exhibited different risk factor profiles than those with basal ganglia infarcts. After adjusting for these variables, the authors found that there is a higher incidence of lacunar infarct in patients with hypertension.
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During a stroke, a blockage in the small arteries of the brain blocks blood flow to the brain. Unlike large arteries, lacunar arteries branch off from smaller, high-pressure arteries. This type of stroke happens inside the deepest areas of the brain and increases the risk of other types of strokes. Early detection is crucial in preventing further damage. You can reduce the risk of future strokes by undergoing regular medical checkups.
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A CTP examination was superior to NCCT/CTA for the detection of lacunar infarcts, according to a study. Ten85 patients who presented with acute stroke symptoms underwent CTP within 12 hours and MRI within seven days of the episode. In these patients, the MRI showed lacunae that were 2 cm in diameter based on NIHSS scores. This study demonstrated that CTP is superior to NCCT/CTA in detecting lacunar infarcts, but there are still limitations with this technique.
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Another drawback of this study is the large number of patients involved in the study. While lacunar strokes are rare, they affect about 25% of all ischemic strokes. During the early stages of the disease, lacunar stroke patients have favorable long-term prognosis. Once the infarct has occurred, the risk of death increases because of cardiovascular causes. As with other types of stroke, the prognosis varies according to the patient's age and vascular risk factors, high nocturnal blood pressure and the severity of cerebral small-vessel disease. The risk of a second stroke is low, but the patient is at increased risk for cognitive impairment and dementia.