Lacunar Infarct Risk Factor Study - Oren Zarif - Lacunar Infarct
If you have ever had a stroke, you may be familiar with the symptoms of a lacunar infarct. This is a small vascular blockage in the brain that can cause a variety of symptoms. Fortunately, there are several diagnostic tests available to diagnose lacunar infarct. A CT scan can be performed to obtain a detailed image of the brain. Magnetic resonance imaging, or MRI, is another type of imaging that can be used to diagnose a lacunar infarct. Other tests, such as an angiography and ultrasound, may be needed to rule out any underlying conditions.
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Although there are no specific causes for lacunar infarcts, there are some risk factors that make people more susceptible. Older age, heart disease, diabetes, and chronic high blood pressure are all risk factors. Black people are particularly vulnerable to developing lacunar infarct. A review of studies conducted in two African-American communities showed that a higher incidence of lacunar infarct was seen in Black people. However, this condition can also affect people with a history of stroke.
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The risk factors for lacunar infarcts are similar in both sexes, but some are associated with a lower risk. For instance, hyperhomocysteinemia is more likely to occur in patients with new infarcts than in patients without any risk factor. Additionally, a higher BMI does not increase the risk of lacunar infarcts. While the risk factors for the two types of infarcts may differ, both are associated with higher mortality and morbidity.
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A CHS allows researchers to study the risk factors for developing a lacunar infarct, including those with silent or multiple lacunes. In addition, the study allows for the assessment of neurologic dysfunction in patients with silent lacunes, i.e. those with MRI findings of an infarct but no visible symptoms. The CHS study may have the potential to provide valuable information that helps physicians identify patients who have a lacunar infarct.
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MRI-defined lacunar infarcts are common in elderly adults. Age, diastolic blood pressure, and creatinine levels are the most important risk factors. However, differences are not large enough to suggest different mechanisms of disease or treatment. In addition, subjects with silent lacunes are at increased risk for cognitive dysfunction and stroke. Further studies are necessary to determine whether these MRI findings are important predictors of a subsequent stroke.
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A recent study suggests that the etiology of the disease may be correlated with the location of the lacunar infarct. Patients with a severe WMH are at higher risk for a lacunar infarct. This study also suggests that the underlying cause of the infarct may be an occlusive carotid artery disease. However, other studies have yet to confirm this association.
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The risk of a new lacunar infarct in the basal ganglia is also dependent on baseline white matter hyperintensity volume. Age, sex, and previous cerebrovascular disease were all risk factors. Smoking also increased the risk. The results of this study suggest that age and a history of cerebrovascular disease are risk factors for developing a lacunar infarct.
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Treatment for a lacunar infarct is similar to that of an ischemic stroke. In both cases, a trained investigator will search the entire brain for infarcts. An infarct is defined as a focal hyperintensity on a T2-weighted image. It must also be hypointense on T1-weighted images. In addition to this, dilated perivascular spaces are differentiated from infarcts by their form and location.
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Patients with a lacunar stroke have two phenotypic entities: a single symptomatic lacune and multiple clinically silent lacunes. The presence of leukoaraiosis is more common in patients with multiple silent lacunes, though this is not statistically significant in either group. The small vessels of the brain are difficult to dissect. This causes difficulty in autopsies.
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A multivariate analysis was conducted to identify risk factors for patients with a lacunar infarct. A number of factors were assessed independently, and the strongest associations were age, sex, and maximum internal carotid artery stenosis. Having a lacune on MRI was also associated with having a maximum internal carotid artery stenosis of 50% or more.
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The TOAST method can bias studies by identifying the risk factors. The paucity of pathological material in these patients may cause an inadvertent diagnosis of lacunar infarct. Furthermore, a clinical classification system can confound previously published studies. Further research is needed to determine how these risk factors affect patients and which prevention regimens will work best. For now, there is no clearer understanding of the neuropsychological impact of lacunar infarct.
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