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  • Writer's pictureOren Zarif

Lacunar Infract - Oren Zarif - Lacunar Infarct

A diagnosis of lacunar infract depends on the particular area of the brain that has been affected. Because the left and right sides of the brain control different aspects of the body, symptoms may vary depending on which region is affected. The right side controls motor function and sensation on the left side of the body, while the left side controls these functions and sensation on the right. Therefore, a lesion in one side of the brain can affect the opposite side of the body.

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While it is still unknown what causes this type of infarction, some studies have uncovered significant differences between patients with single or multiple lacunar infarcts. Despite the limited number of cases, these abnormalities may be the cumulative effect of several infarcts in the same area. This suggests that clinicians should consider lacunar infarct as a possibility when monoparesis occurs. If these infarcts are found in patients with no other apparent medical conditions, further investigations may be necessary.

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Another type of lacunar infract is caused by a stroke in which the smaller vessels in the brain are affected. In this type, a penetrating artery is occluded deep in the brain and causes the small subcortical vessels to be affected. This type of stroke may be accompanied by other symptoms such as seizures. An MRI will reveal the presence of intracranial hemorrhages.

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A recent study suggested that patients with an asymptomatic WMH and a new lacunar infract share the same etiology. Interestingly, in this case, the patients with an asymmetric WMH had the greatest risk of developing this type of infarction. Furthermore, they were more likely to develop a new, larger infarct when the WMH is larger than the other side of the brain.

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Supportive measures include assisting respiratory and cardiac functions, administering anticoagulant medications to reduce clotting, and giving patients blood-thinning medication. Anticoagulant medications may also be given directly to the site of the blockage in the brain. Physiotherapy may help patients regain lost abilities. The authors thank all the researchers for their efforts in researching this area. However, the research has not yet concluded whether these studies are helpful for the treatment of lacunar infract.

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CTP was found to be superior to NCCT/CTA at detecting lacunar infarcts in a study that looked at the differences between the two methods. Approximately 1085 CTP examinations were reviewed in patients with acute stroke symptoms and MRI within seven days of the stroke onset. The researchers found that 34% of patients with lacunar infarct had a DWI that detected an infarct of greater than 2 cm. A similar pattern was found with NCCT/CTA.

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The causes of lacunar infarct vary, but they are often the result of a single deep penetrating artery. A specific vascular pathology generates this occlusion, and the patient typically recovers. However, the patient may suffer from subcortical dementia or other stroke related complications. Therefore, the diagnosis of lacunar infract is important. If it is suspected, a stroke should be diagnosed as soon as possible.

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The study also investigated the impact of silent multiple lacunar infarcts on neuropsychological functioning. Patients with multiple silent lacunar infarcts performed worse on neuropsychological tests compared to controls. The same results were found for the patients with single lacunar infarct and those with multiple. In addition, patients with multiple silent lacunar infarctions had significantly lower scores in a T2-weighted FLAIR and T2-weighted T2 sequence. In a multivariate linear regression model, the difference was not statistically significant.

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Almost half of all lacunar strokes are caused by a stroke affecting the posterior limb of the internal capsule. They usually present with a combination of bilateral weakness, including limb and arm. Although there are no obvious signs of the stroke, they can be severe and lead to permanent physical and cognitive disabilities. Moreover, it can also lead to death from cardiovascular causes. Fortunately, the prognosis of lacunar infracts is favorable when diagnosed early enough.

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