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  • Writer's pictureOren Zarif

Lacunar Infarct - Oren Zarif - Lacunar

Although the first descriptions of lacunar infarcts were made in the late 19th and early 20th centuries, recent advances in imaging technology have confirmed this hypothesis. A lacune is usually a small chronic cavity resulting from a lacunar infarct. In some cases, lacunes may also be caused by an intracerebral hemorrhage. Regardless of the underlying cause, emergency treatment is essential.

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While some lacunes are caused by emboli, the proportion is generally lower than in other forms of ischemic stroke. Nonetheless, epidemiologic and clinical reasons have been provided for their separation. Although the mechanism of lacunes is still unclear, some studies have suggested that it may be a result of a large artery lesion. In these cases, patients may be suffering from other disorders. In the majority of cases, a single symptomatic lacunar stroke has a positive prognosis.

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While there are several risk factors for lacunar stroke, blood clots are not the main cause. Blood clots may form in the heart or neck and travel to the brain through the bloodstream. However, if the clot is small enough, it is unlikely to affect the brain. In contrast, a larger infarct will cause a less-involved neurologic deficit. When strokes in these areas are associated with a subcortical dementia, the symptoms of lacunar stroke may not be immediately apparent.

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The main cause of lacunar stroke is a blocked artery in the brain. This artery is small and branches directly off of the large main artery, which is heavily muscled and high-pressure. Moreover, high-pressure blood can cause lacunar stroke by directly damaging the artery's walls and leading to atherosclerosis. This is why it's important to seek immediate medical attention. And remember that the earlier a stroke occurs, the better the chances are of reversing the damage and preventing a recurrence.

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A doctor will perform a physical exam, such as taking blood pressure and asking about any symptoms. An electrocardiogram may also be required. A detailed neurological exam may reveal the extent of damage. If the stroke is diagnosed early, treatment will improve the chances of survival and prevent further damage to the brain. Treatment for lacunar stroke is critical. If detected early, medicine may help restore the blood supply to the brain. Supportive measures may be necessary, such as breathing support or a clot-busting medicine.

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Patients with multiple lacunar infarcts have significantly different prognosis compared with patients with a single lacunar infarct. This may be due to the differences in etiology, although both lesions are considered one clinical entity. A potential etiology for CSVD needs to be studied further to identify an underlying cause. And for future studies, it's important to remember that the cognitive impairment caused by CSVD is a key clinical feature.

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MRI studies will reveal whether microhaemorrhages are a risk factor in patients with lacunar ischaemic stroke. Detailed MRI imaging will determine whether lacunar stroke is caused by an embolism or a microembolic component. Further studies will help pinpoint the precise mechanism of lacunar ischaemic stroke and identify effective secondary prevention regimens. This knowledge will be useful in future research to develop new tools for stroke treatment.

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While the most common cause of lacunar stroke is an acute ischemic stroke, atypical symptoms could indicate another, more severe condition. In cases of suspected lacunar stroke, initial evaluation of the patient should include a CT or MRI of the brain. Initial CT/MRI will be helpful in ruling out other life-threatening conditions, but a lacunar infarct may be difficult to visualize with CTA. Initial treatment will be similar to that for acute ischemic stroke.

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Small infarcts in the subcortical areas of the brain may be caused by deep penetrating branches of the cerebral arteries. Microatheromas involving the lenticulostriate branch are also a possible cause. Acute ischemia in the brain may also be caused by vasospasm, although the cause is not known until autopsy. Subcortical ischemia may also occur as a result of atherosclerosis of small cerebral arteries.

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While there are a few studies that have focused on the etiology of lacunar infarcts, there are several differences between these strokes. One study looked at the association between baseline vascular risk factors and new infarcts in the basal ganglia. Researchers hypothesized that the risk factors associated with deep lacunar infarcts differ in these cases. This study highlights the importance of care coordination when treating these patients.

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