Lacunar Infract - Oren Zarif - Lacunar Infarct

Lacunar infarcts are small vascular occlusions that form in peripheral arteries. They must be less than 15 mm in diameter and are thought to be caused by an embolism, lipohyalinosis, or in situ microatheroma formation. These infarcts are characterized by an irregular cobweb-like structure with fibrous strands. The lesions appear as ill-defined hypodensities in the brain. The presence of lacunar infarcts in the brain can indicate a range of conditions and the need for emergency treatment.

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After identifying the underlying cause, doctors will perform a complete neurological examination to determine whether the condition is related to an underlying disease or a stroke. Often, an anticoagulant is given directly to the blood clot, and a patient may be given aspirin or another medication that can prevent clotting. Sometimes, supportive measures are necessary to improve breathing and heart function. However, treatment of lacunar infarcts will depend on the severity of the symptoms.

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The most common lacunar infarcts occur in the deep white matter, where the brain tissue has more oxygen and water than the rest of the brain. A MRI of the brain can show the depth of the lesion, whether it is isolated or part of a larger lesion. In rare cases, a lacunar infarct may be associated with an occlusive carotid artery, although it is not yet known.

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While many types of stroke are associated with a low risk of lacunar infarcts, some groups are at an increased risk. People with diabetes, heart problems, or chronic high blood pressure are particularly at risk. Black people may be more likely to develop this condition. Studies conducted in different communities indicate that there is a statistically significant increase in the incidence of lacunar infarct among Black people.

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In the CHS study, 3660 older adults were screened for ischemic strokes and subsequently diagnosed with an MRI. Of those, 1131 had an ischemic infarct and 841 had a lacunar infarct, and the majority of them did not report any stroke history. The study showed that patients with lacunes have increased risk of cognitive dysfunction and lower extremity stroke.

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Although there is no definitive evidence linking chronic hypertension to a higher incidence of lacunar infarct, patients who suffer from other cardiovascular risk factors may be at increased risk for the disease. Other risk factors include hyperhomocysteinemia and atrial fibrillation. Some patients also have a family history of cerebrovascular disease, which may increase their risk of developing lacunar infarcts.

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The symptoms of a lacunar infarct depend on which part of the brain has been damaged. Because different areas of the brain control different aspects of the body, a lesion on one side of the brain can affect the opposite side of the body. Therefore, a diagnosis of lacunar infarct should be made quickly. If a stroke is suspected, doctors may recommend surgery. A doctor should also order a detailed brain scan. The MRI will reveal if a hemiplegic lesion is present.

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While the risk factors for lacunes vary between the four subgroups, age and gender are strong independent predictors. The study found that older age, higher diastolic blood pressure, and higher creatinine levels were associated with increased risk for a lacune. MRI evidence of lacunes was also associated with a higher stenosis in the internal carotid artery.

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To better understand the underlying mechanism of a lacunar ischaemic stroke, more research is needed. Detailed patient classification is needed to determine risk factors for this condition. Detailed MRIs may help distinguish lacunar ischaemic stroke from those caused by emboli. MRIs of small arteriolar abnormalities may also help to understand the mechanisms of lacunar ischaemic stroke. This could also identify diagnostic and prognostic markers for patients who are at risk for a lacunar stroke.

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When a stroke occurs in the deep brain, small arteries become blocked. These arteries branch off a larger high-pressure artery. When the blood flow is interrupted, the brain is deprived of oxygen. Within minutes, cells in the brain begin to die. Despite its lack of recognizable symptoms, a lacunar infarct can lead to life-long disabilities. Symptomatic treatment may be difficult without proper diagnosis.

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In patients with a lacunar infarct, MRIs show the presence of multiple silent infarcts. These are associated with mild neuropsychological abnormalities. They include cognitive decline and short-term memory loss. Further, the presence of leukoaraiosis or perivascular hyperintensities are not associated with the development of the syndrome. This study has also led to the development of a risk factor for a lacunar infarct in patients with multiple other types of stroke.