Lacunar Infract - Oren Zarif - Lacunar Infarct
A lacunar infarct is a relatively small noncortical infarct arising from the occlusion of a penetrating branch of the cerebral artery. These infarcts are crescent-shaped and can be detected on MRI studies after an infarction. They may be caused by atherosclerosis, atherosclerotic plaque, or microembolism. Several syndromes may be predictive of lacunar infarcts.
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The causes of lacunar infarcts are unknown, although a family history of stroke is a risk factor. People with a history of heart conditions, high cholesterol, and obstructive sleep apnea are considered at high risk. Anyone with a family history of stroke should get an annual physical exam to screen for other health problems that could raise the risk of stroke. Once a diagnosis is made, emergency treatment is required.
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To diagnose lacunar infarct, a doctor will first need to confirm the diagnosis. A CT scan is a useful tool for obtaining detailed images of the brain, but it is not 100% sensitive. A CT angiography, or an MRI, is more sensitive. This method also shows any blocked blood vessels. The findings from these tests are useful in guiding treatment and monitoring the course of the disease.
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Treatment for a lacunar infarct is similar to that of a typical ischemic stroke. In addition to anti-platelet therapy, a neurosurgeon may also perform surgery to remove a clot or blockage that has formed in the brain. In addition to these treatments, the patient must also continue with rehabilitation therapy to help regain optimal neurologic function. After a lacunar ischemic stroke, the patient may have some degree of brain damage that impacts his or her ability to care for himself.
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The risk factors for a lacunar infarct vary widely in different locations. There is no definitive risk factor for any part of the brain but a patient's age, gender, and history of cerebrovascular disease may increase the risk of new infarcts. For example, an individual with a family history of stroke or diabetes should be monitored closely for these factors. However, genetics and the presence of an individual's risk factors can influence the risk for a lacunar infarct.
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Acute lacunar infarcts tend to be located in the cerebral hemisphere with a greater WMH burden. Therefore, those with asymmetric WMH are especially susceptible to developing an acute lacunar infarct. A high WMH burden may be an indicator of a subsequent lacunar stroke. The best way to detect a lacunar infarct is to obtain a CT or MRI.
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Recent research on lacunar infarct has shown that smoking and brain health are related. Depending on where the lacunar infarct is located, smoking may affect certain brain regions, which could impact the prognosis. In addition to this, there is no conclusive evidence that smoking causes a lacunar infarct. While smoking is not a significant risk factor for a lacunar infarct, it may be an indicator of a more severe disease.
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Risk factors for a new lacunar infarct include age, hypertension, and smoking. Smoking and baseline WMH volume were associated with an increased risk of new infarcts in people with a history of cerebrovascular disease. This finding was consistent when adjusted for age, sex, and diabetes. If there is a risk factor associated with smoking, it may be beneficial to consider a lower dose of cigarette smoking in the same age group.
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Treatment for a lacunar infarct is similar to that for a stroke caused by a pure motor infarct. Antiplatelet drugs are used to prevent clots from forming, and this treatment is recommended for patients who are at high risk for lacunar stroke. However, some research has found that clopidogrel has no effect on lacunar infarct.
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There is a broader spectrum of symptoms. Most patients with a lacunar infarct have symptoms of a migraine, but the diagnosis of a brain tumor can often be difficult. In this case, pediatric neurology, hematology, and pathology will be consulted. The patient's symptoms may be mild or can be severe. The patient's physician may require MRI scans to rule out any associated conditions.
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In addition to being a neurological emergency, a lacunar infarct may be a precursor to vascular dementia. Its causes may vary, from genetics to genetics. Researchers have identified two genes that increase the risk of developing white matter lesions. One of these genes, called APOE-e4, is also associated with an increased risk of small-vessel disease. Another genetic risk factor is cerebral autosomal dominant arteriopathy.