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  • Writer's pictureOren Zarif

Lacunar Infract - Oren Zarif - Lacunar Infarct

There are several factors that can contribute to the development of a lacunar infarct, including advanced age, diabetes mellitus, and smoking. Patients with prior history of stroke or cerebrovascular disease may also be at increased risk for developing this condition. Fortunately, early diagnosis and treatment can significantly improve patients' chances of survival. Medications that lower the risk of stroke, such as aspirin, may also be prescribed.

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Supportive measures may also be required to support heart and breathing functions.

Neuroimaging tests may be ordered to help differentiate between different types of stroke. During a clinical exam, doctors will perform a complete brain scan, such as MRI, to confirm the diagnosis. A Doppler ultrasound may also be performed to monitor blood flow and heart function. Some tests, such as an electrocardiogram, may be ordered. A specialized lab will also order an electrocardiogram to determine the cause of the infarct and monitor the patient's heart and kidney function.

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In recent years, researchers have been investigating the risk factors for lacunar infarcts in the basal ganglia. However, this type of stroke is thought to be more severe than the other type and may not necessarily progress to a higher level. One study looked at the association of baseline vascular risk factors with new infarcts in the basal ganglia. There were no associations between patients' risk factors and their subsequent development of a lacunar infarct, but researchers do know that it is not the same for every type of stroke.

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The MRI scans also allowed researchers to examine risk factors for individual subjects with silent lacunes. The authors of the study found that 3660 participants in the Cardiovascular Health Study reported the development of a lacunar infarct. Only 7% of these patients had previous stroke or TIA. Although this group does not fully represent the overall population, it is an important indicator of the increased risk of stroke.

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If the stroke has progressed to the point where the patient cannot move their arms or legs, he or she may be suffering from a lacunar infarct. However, a doctor should be consulted for a lacunar infarct in cases of monoparesis. A diagnosis is crucial to avoid the development of a larger infarct. In the meantime, it is important to remember that a lacunar infarct can be fatal and requires emergency treatment.

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Treatment for patients with a lacunar infarct is similar to that for ischemic stroke. A combination of medications and mechanical devices may be used for thrombolysis. Thrombolysis may be performed with the use of drugs to break up blood clots. After the procedure, blood thinning drugs are prescribed for 90 days. The study is important for determining the cause of a patient's stroke.

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MRI is the most accurate imaging modality for diagnosing lacunar infarct. DWI is highly useful in determining the extent of an infarct. Furthermore, MRI can differentiate between acute and chronic infarction. Acute lesions are identified by focal areas of decreased signal intensity in T1 or T2-weighted images, while chronic lesions have an isointensity in CSF.

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In a recent study, investigators identified a higher prevalence of occlusive carotid artery disease, and a reduced prevalence of middle cerebral artery disease and embolic source in patients with a lacunar infarct. The authors noted that the two types of infarcts differ in size, although both were defined as periventricular lesions. Further studies are needed to establish which is the more common type of the two.

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Patients with a recent history of a lacunar infarct should seek immediate medical care. If a stroke has occurred, patients may be given aspirin to decrease the risk of another. Anticoagulant medications such as aspirin are given directly to the site of blockage in the brain. Physiotherapy is also used to help patients regain abilities that they may have lost. While antiplatelet drugs may help reduce the risk of a recurrent ischemic stroke, they may not work well enough.

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The risk factors that increase the risk of lacunar infarcts include hypertension, smoking, and baseline WMH volume. Although hypertension and smoking are known risk factors for a lacunar infarct, they do not appear to be predictive of a new WMH. These findings suggest that the prevalence of hyperhomocysteinemia is increasing in these patients. Therefore, it is important to identify these risk factors and treat them accordingly.

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There are several methods used to identify a lacunar infarct. CTP is superior to NCCT/CTA in detecting these infarcts. One study evaluated the sensitivity of CTP in identifying lacunae by analyzing 1085 CT examinations performed in patients with acute stroke symptoms. All patients were given MRIs within seven days of the event and were evaluated for lacunar infarct using NIHSS scores.

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