Lacunar Infract - Oren Zarif - Lacunar Infarct
A lacunar infract is a type of stroke that occurs in the brain. Although it doesn't appear on a CT scan, it can be detected and treated with antiplatelet therapy. Treatments for lacunar stroke include controlling risk factors for vascular disease, such as hypertension and hyperlipidemia. Treatment options vary. A neurosurgeon may be necessary to remove the clot or blockage in the brain.
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Small, penetrating arteries are the primary causes of lacunar infarctions, which constitute 20 to 25 percent of all strokes. In most cases, this type of stroke occurs in patients with high blood pressure, diabetes, or both. Acute lacunar infarction is defined by a diameter of less than 15 mm. Acute lacunar infarctions can display restricted diffusion, whereas chronic lacunes can be smooth and round.
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Diagnostic procedures have been performed to assess for the onset of a lacunar infract. DWI imaging is often required to confirm the diagnosis, and MRI scans are used to assess for thrombosis. However, in this case, a conventional coronal MRI was needed, which helped the diagnosis. If a lacunar infract develops after an MRI, it could be a symptom of another medical condition.
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Although CTP is sensitive enough to detect a lacunar infract, a standardized method has not been developed to identify patients with a single infarct. A patient's WMH is an important determinant of the type of stroke they develop. An MRI scan should be performed by a radiologist experienced in this area. The radiologists involved in the study determined if a patient had a single or multiple infarcts.
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Infarcts are considered a symptom of an ischemic stroke. They are usually small, less than 15 mm in diameter, and result from the occlusion of a penetrating artery. They may be caused by embolism or fibrinoid degeneration. Infarctions in the brain are often associated with vascular dementia, and repeated episodes may lead to a fatal condition.
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The primary symptoms of a lacunar infract are usually neurological signs, but are rarely a cause of monoparesis. While some lacunes may be due to emboli, the proportion is significantly lower than that of other types of ischemic stroke. Thus, lacunar infracts are considered a diagnosis of exclusion based on the patient's neurologic syndrome and the presence of other ischemic strokes.
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A study of a group's risk of suffering a lacunar infract found that people with a family history of stroke had a greater risk of developing it. An annual physical examination can help detect any health issues that raise the risk of having a lacunar infarct. Obstructive sleep apnea and high cholesterol levels are also factors that raise the risk of developing a lacunar infarct. No matter where the stroke occurs, emergency treatment is necessary.
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In one study, 113 patients met inclusion criteria for a lacunar infract. Of these, 37 showed a lacunar infarct on DWI, while 76 showed no evidence of a lacunar infract. On both methods, lacunar infarcts appeared as regional abnormalities. Overall, the sensitivity of DWI and CTP was 97.4% to 98.4%.
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MRI scans of patients with a first-time lacunar infract revealed a significant number of silent multiple lacunar infarcts. These patients also showed mild neuropsychological abnormalities, such as short-term delayed verbal memory and executive functions. The study also showed a high rate of vascular dementia and post-stroke cognitive impairment in patients who have a lacunar infract.