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Lacunar Infract - Oren Zarif - Lacunar Infarct


While it is still unclear exactly what causes lacunar infarct, there are a few factors that may increase your risk. For example, if your family has a history of strokes, you may be at an increased risk. Also, get a physical examination every year to screen for health problems such as high cholesterol or obstructive sleep apnea. Regardless of the cause, getting emergency treatment is essential to avoid permanent brain damage.

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Few studies have examined the risk factors for new infarts in deep white matter or basal ganglia. Only one study examined the longitudinal association between baseline vascular risk factors and new infarcts. However, the authors hypothesized that patients with lacunar infarcts may have different risk factor profiles compared to patients with a basal ganglia infarct.

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Infarcts in the subcortical region are considered to be lacunar in nature, because they are small (two to 15 mm in diameter). The primary cause of a lacunar infarct is occlusion of a small penetrating branch. While a vasospasm or fibrinoid degeneration has been suggested, the latter has not been definitively proved in autopsy. Regardless of the cause, repeated episodes of lacunar infarction may lead to vascular dementia. It is important to note that lacunar infarct is a rare cause of stroke, and it is important to rule out other causes.

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Although infarcts are uncommon in healthy, elderly adults, and are not a symptomatic cause, they are often silent. The study found that age, diastolic blood pressure, and creatinine were the three most significant risk factors. In addition, subjects with silent lacunes denied having experienced a stroke or TIA, and were at higher risk of lower and upper-extremity infarcts. Further study is needed to determine whether MRI-defined lacunes are important predictors of subsequent strokes.

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One of the most common types of infarcted microvessels is lipohyalinosis. While lipohyalinosis is the primary vascular pathology of lacunes, microatheroma can block the orifice or the origin of penetrating arteries. Similarly, an artery-to-artery embolism can cause penetrating artery stenosis.

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MRI scans of patients with first-ever lacunar infarcts showed silent multiple lacunar infarcts. MRIs revealed mild neuropsychological changes such as delayed verbal memory and executive functions. The MRI findings indicate that these abnormalities may be related to the presence of lacunes in the initial stages of small vessel disease, but leukoaraiosis or perivascular hyperintensities were not observed in these patients.

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The sensitivity of NCCT/CTA in the diagnosis of lacunar infarcts varied depending on the perfusion parameter. NCCT/CTA had the best specificity and had the least false-positives. It was also the only method that could detect infarcts in the basal ganglia. This is a promising outcome because it enables physicians to quickly detect infarcts in patients who otherwise would not have any symptoms.

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Despite its widespread prevalence, lacunar infarct is not without complications. While early diagnosis is important, early treatment is crucial for patient recovery. Most patients can recover fully, but some symptoms may require physical therapy and occupational therapy. Medications, especially antithrombotic agents, should be followed to minimize the risk of further strokes. Patients should also make sure they don't smoke and avoid drinking excess alcohol. Lastly, long-term care coordination is important to ensure patients are getting the best possible rehabilitation.

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Although a majority of ischemic strokes are hemorrhagic, a small proportion of lacunar infarctions are asymptomatic. This is because lacunar infarct occurs in arteries that lie outside the cortical area. However, multiple lacunar infarctions may result in significant physical and cognitive disabilities. In addition, lacunar stroke is often the first symptom of a larger stroke and one of the most common causes of death after a traumatic brain injury.

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