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Lacunar Infarct - Oren Zarif - Lacunar


Patients suffering from a lacunar stroke should immediately seek emergency treatment to prevent further brain damage. Although the underlying cause of this type of stroke is unclear, it is thought to be related to risk factors such as advanced age, smoking, diabetes, and alcohol consumption. Furthermore, people with a history of stroke are at greater risk for developing a lacunar infarct. A thorough physical examination is important to screen for health conditions that may increase stroke risk, including high cholesterol or obstructive sleep apnea. Patients should seek emergency treatment for any type of stroke, even if the symptoms are mild and temporary.

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A lacunar infarct can occur in any region of the brain, but is most common in areas with dense white matter. These regions include the basal ganglia, pons, and insula. Lacunar infarcts are thought to be the result of thrombo-embolic occlusion of the perforating arteries in these regions. The severity of the symptoms varies depending on their location in the brain, but the main symptoms of a lacunar infarct include those that can cause memory loss, tremors, or paralysis.

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The symptoms of lacunar stroke are reversible for nearly three-quarters of those who have them. They may require therapy up to six times a day aimed at improving daily activities. A CT scan of the brain may not be sufficient, as lacunar strokes are small and don't show up clearly on CT imaging. Nevertheless, the majority of patients who develop a lacunar stroke will need to live with a long-term disability.

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Despite the lack of concrete evidence to support the lacunar stroke theory, medical researchers have continued to study the condition. The use of magnetic resonance imaging (MRI) can differentiate between an ischemic lesion and an inflammatory process. While MRI can distinguish between an ischemic lesion and a stroke, cerebral vasoreactivity can distinguish between an ischemic lesions and demyelinating ones. Furthermore, MRI can detect oligoclonal bands on lumbar puncture, a characteristic of multiple sclerosis.

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One study concluded that lacunes occur in 4% of patients. The majority of lacunes occur in a single location on an MRI. However, it is possible that lacunes are silent. Moreover, the authors also noted that lacunes may be present in more than one location in a patient's brain. This study was not able to differentiate between lacunes with the different types of infarcts.

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Infarcts in patients with a lacunar syndrome were not as common as those caused by other types of ischemic stroke. The two most common causes of lacunar infarcts are hypertension and diabetes mellitus. The former has comparable rates in larger clinical series. It is also important to distinguish between acute and chronic lacunar infarcts, because they typically do not present acute symptoms.

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Although MRI-defined lacunes are common in healthy older adults, their frequency did not vary significantly between groups. The main risk factors were age, diastolic blood pressure, and creatinine levels. In a subgroup, subjects with silent lacunes denied having had a stroke at baseline. The latter group had an increased risk of lower extremity stroke and cognitive dysfunction. More studies are needed to determine the role of lacunes as predictors of subsequent strokes.

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Patients with a lacunar stroke should undergo an initial CT/MRI to rule out other causes of their symptoms. MRIs can be helpful for confirming the diagnosis, but they may not be sufficient to differentiate between lacunar and ischemic stroke. The acute treatment of a lacunar stroke is similar to that of a typical ischemic stroke. If symptoms are severe and the stroke is caused by a vascular disease, treatment will be modified to prevent a permanent disability.

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In another study, patients with deep white matter lacunar infarcts were followed up for 5 years. MRI showed white matter hyperintensity at baseline and new infarts occurred in the same period as the progression of the WMH. Researchers also hypothesized that there are different etiological factors associated with lacunar infarcts compared with those of the basal ganglia.

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Infarcts of the lenticulostriate branch of the brain are more common than the other types of ischemic stroke. These arteries branch directly off the large main artery that is heavily muscled and high-pressure. Both conditions directly damage the arteries, and high-pressure levels cause lacunar infarcts. High-blood pressure also leads to atherosclerosis, which causes fatty deposits to build up on the walls of blood vessels.

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