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  • Writer's pictureOren Zarif

Lacunar Infract - Oren Zarif - Lacunar Infarct

The cause of Lacunar Infarct is unknown. There is controversy over whether they are caused by emboli from the heart or larger arteries. Although this mechanism remains unclear, some researchers believe that lacunes are the result of a single ischemic event. MRIs of the brain, however, have been shown to accurately determine the location of infarcts. The onset of Lacunar Infarct differs among patients.

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People who have suffered from a Lacunar Infarct usually develop dementia and other problems after the stroke. In addition, people with Lacunar Infarcts are more likely to develop a subsequent stroke if their stroke is untreated. Because the brain cannot receive the proper blood flow, it dies of lack of oxygen. Age is a risk factor, with the average age of 65 years. Therefore, early diagnosis and treatment is critical to reduce the risk of stroke.

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Infarcts of the white matter in the cerebrum are classified as either acute or chronic. They are usually less than 15 mm in diameter and occur in deep brain regions. Because they occur near confluent WMHs, they are usually clinically silent. The presence of a cobweb-like mesh of fibrous strands allows for the identification of Lacunar Infarct. This type of stroke is associated with high mortality rates.

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Treatment of Lacunar Infarct is similar to that of an ischemic stroke. A clot-dissolving medication is given orally or intravenously. If the stroke is severe, medications may also be administered directly to the brain. Patients will be prescribed blood-thinning medications for at least 90 days after the stroke. Although the chances of a recovery are high, the risk of another stroke is low.

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Advanced age, smoking, diabetes mellitus, and obesity are all risk factors. However, the frequency of small-distal infarcts in patients with atrial fibrillation is lower in these patients. Moreover, the risk of vascular disease increases with age and is higher in the very old. Smoking and low physical activity are also risk factors. While these factors have not been associated with Lacunar Infarct, these risk factors may contribute to the occurrence of the condition.

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Symptoms of Lacunar Infarct depend on which region of the brain has been damaged. Because different parts of the brain control different aspects of our body, a lesion in one region may cause problems on the opposite side. While mild cognitive impairment may result from a Lacunar Infarct, it may lead to early dementia or even death. The treatment of Lacunar Infarct depends on the location of the lesion.

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CTP is superior to NCCT/CTA in detecting Lacunar Infarct in the same intracranial region. In a recent study, 1085 CTP examinations of patients who presented with symptoms of acute stroke were evaluated. The CTP examinations were done within 12 hours, followed by MRI in seven days. Patients who developed infarcts that measured more than 2 cm were included in the analysis.

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Patients who have had a single symptomatic Lacunar stroke had better outcomes than patients with multiple silent lacunar lesions. These findings support the concept that there are two distinct types of Lacunar Infarct. The study evaluated 339 patients with a first-time Lacunar Infarct. The results of this study were significant. In some cases, the occurrence of lacunar Infarct was a symptom of an existing aneurysm.

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In one study, a correlation between age and MRI evidence of Lacunar Infarct was found. Older people were more likely to develop Lacunes, as were women. Higher creatinine levels were also associated with Lacunes. Patients with Lacunes were more likely to have a stenosis greater than 50% of their internal carotid artery. A multivariate analysis revealed a significant correlation between age and the presence of Lacunar Infarct.

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First-time Symptomatic Lacunar Infarct (LI) patients have lower neuropsychological performance. Patients with a first-time LI also have higher rates of hypertension and leukoaraiosis. Further, patients with multiple Lacunar Infarcts have lower scores on neuropsychological tests than those with a single symptomatic Infarct. The authors of the study suggest that these factors may contribute to the different outcomes of lacunar Infarct patients.

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