Lacunar Infarcts and WMH - Oren Zarif - Lacunar
A recent study suggests that the development of new deep white matter lacunar infarcts is associated with the progression of WMH. In this study, researchers assessed the risk of developing a lacunar infarct in patients with recent WMH. They used Poisson regression models, adjusted for age and sex, to calculate the risk of developing a new infarct. Interestingly, both sexes were associated with increased risk.
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In healthy older adults, MRI-defined lacunar infarcts are common. Although age, diastolic blood pressure, and creatinine were significantly associated with the development of this vascular condition, the differences among subgroups were not large enough to suggest different mechanisms of disease. Additionally, subjects with silent lacunes (denial of any previous stroke) were at increased risk of upper and lower extremity strokes. Further studies are needed to determine the clinical significance of lacunes as a predictive factor of subsequent stroke.
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Lacunar strokes typically affect the motor and sensory areas of the brain. Damage to the thalamus causes sensory loss and motor abnormalities on the same side of the body. Affected people may wobble or have weakness in their leg or arm. Fortunately, the facial area is rarely affected by lacunar strokes. However, in patients with multiple lacunar infarcts, there are some differences that need to be identified.
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Most people with a lacunar stroke also have hypertension. Hypertension, as well as diabetes mellitus, are common risk factors for both types of stroke. Hypertension and diabetes mellitus are the most common vascular risk factors, and have been demonstrated to be independently associated with lacunar infarcts. However, studies of risk factors have mostly relied on the clinical diagnosis of lacunar infarcts.
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Symptomatic patients who have suffered a lacunar stroke are more likely to experience memory loss. Older people who have suffered a lacunar stroke are also at an increased risk for developing dementia. In addition, some lacunar strokes are associated with fatty deposits in the bloodstream, which can lead to atherosclerosis. Once atherosclerosis has occurred, it makes arteries more susceptible to blockage. As a result, a stroke with a lacunar origin is more likely to occur in a patient with a fatty deposit in the bloodstream.
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There are several possible causes of a lacunar infarct, including a deep penetrating branch occlusion, a microatheroma involving the lenticulostriate artery, and a parent artery occlusion. Infections and vasculitis may also lead to a lacunar infarct. Although autopsy does not confirm the cause, the condition is commonly associated with atherosclerosis of the small cerebral arteries.
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Patients who have undergone a laminectomy for a stroke with a lacunar infarct were also diagnosed with lacunar syndrome. During the same time period, patients with primary intracerebral hemorrhage and spontaneous subdural haemorrhage had a non-lacunar infarct. A study of the prevalence of lacunar infarction in patients who have a lacunar syndrome revealed that lacunar infarct may occur in a small percentage of cases.
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Although a lacunar infarct usually isn't accompanied by any symptoms, the resulting brain cells are dead. Lacunar strokes are rare but are still serious and can lead to early or severe cognitive disability. It is important to seek immediate medical attention if you suspect you have a lacunar stroke. It is vital to recognize these occurrences to prevent the damage they cause. If left untreated, these strokes may lead to significant neurological damage.
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These findings suggest a role for MRI in the evaluation of patients with lacunes. The MRI models include sex, age, and gender as potential risk factors. However, there are no factors that consistently predict the development of a lacunar infarct. A lacunar infarct may be a sign of a more general disease, such as a heart attack, stroke, or ischemic stroke.