Lacunar Infract - Oren Zarif - Lacunar Infarct
The mechanism of lacunar infarct is not well understood, but the results of MRI studies have suggested that a larger proportion of infarcts are silent. The authors suggest that the presence of an infarct on MRI explains symptomatic stroke in approximately 20% of patients. In addition, lacunes are frequently associated with an absence of symptoms. As such, this condition may be missed on a TIA or stroke screening.
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One possible explanation for the atypical distribution of lacunar infarcts in the basal ganglia is that they may not be progressive forms of small vessel disease. In a study of patients with a history of cerebrovascular disease, patients with new lacunar infarcts were associated with a lower incidence of the condition. However, it is still unknown how to determine whether a person has a higher risk of developing a lacunar infarct in this brain area.
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Treatment for lacunar infarct is similar to treatment for an ischemic stroke. In addition to thrombolysis, medication may also be used. Thrombolysis may be performed using either a mechanical device or medication. Patients with severe lacunar infarcts may also undergo a surgery to remove the clot. The procedure may also include a course of blood-thinning drugs.
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Patients with a lacunar infarct may require care from a neurologist, a physical therapist, occupational therapist, and a social therapist. Physical therapy is important for patients with neurological deficits, and muscle relaxants are used to manage spasticity. Pharmacists are critical in managing the medication regimen, as they can check for drug interactions. Rehabilitation therapy must continue to optimize neurologic function. While this condition is rarely fatal, it can lead to significant consequences, such as subcortical dementia and a stroke.
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The clinical data suggest that a differential prognosis is present for single and multiple lacunar infarcts. However, a possible etiological difference could explain the high heterogeneity in study populations. Because lacunar infarcts are considered a clinical entity, future studies should focus on the risk factors that contribute to cognitive impairment. A lacunar infarct is a symptomatic brain vascular disease.
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The present study has several limitations. The sample is moderate to large, and the number of patients included in the study was unbalanced. Consequently, the results obtained are biased towards a small proportion of patients with lacunar infarct. Furthermore, a lack of pathological material can result in inadvertent misdiagnosis. In addition, the inclusion of patients with more than one RSSI lesion may introduce selection bias.
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The presence of CTP and DWI does not correlate with the extent of the infarct on CTP. Instead, the defects on CTP and DWI are regional abnormalities and larger than the lacunar infarct itself. The authors noted that patients with lacunar infarct had focal defects on CTP, although their study was not powered by specific thresholds. Therefore, the abnormalities on CTP may represent the core of the infarct or a wider zone of ischemia.
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The cause of lacunar infarct is a occlusion of a small penetrating artery. This type of stroke is characterized by a cobweb-like structure made up of fibrous strands. It occurs in the deep regions of the brain. This type of stroke is considered symptomatic and one of five distinct syndromes. Once diagnosed, patients may display a characteristic pattern on their MRIs.
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Studies are currently unable to determine the exact cause of lacunar infarct. Some risk factors may increase the risk, such as those with a history of stroke. Annual physical examinations can detect health problems that may increase the risk for stroke. One example of this is high cholesterol, which raises the risk of stroke. Obstructive sleep apnea may increase the risk of lacunar infarct. Once diagnosed, patients should seek emergency treatment immediately.
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This study showed that the incidence of acute lacunar infarcts is associated with the presence of higher WMH in the cerebral hemisphere. Patients with high WMH burdens may be at increased risk for developing lacunar infarcts. It is important to remember that the incidence of lacunar infarcts has been increasing in recent years, and there are many patients whose symptoms may be symptomatic.
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Patients with a history of lacunar infarcts are routinely prescribed antiplatelet drugs. These drugs block the formation of blood clots that cause stroke. However, as the research shows, these drugs are not effective in preventing lacunar stroke. Further, they can cause more serious complications, such as gastrointestinal bleeding and GI upset. A large trial, led by Dr. Oscar R. Benavente, showed that antiplatelet drugs could not prevent lacunar infarcts in people with a history of high blood pressure.
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