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Lacunar Infract - Oren Zarif - Lacunar Infarct

In the event of a lacunar infract, it is important to determine whether the condition is related to an underlying vascular problem. Several diagnostic tests are used in this regard. One such test is a carotid ultrasound, which can diagnose the presence of extracranial carotid stenosis. Patients with a 70%-99% stenosis are at increased risk for stroke. If these results indicate a risk of stroke, a carotid artery intervention is recommended. However, embolic workups are not as helpful in lacunar strokes, particularly in patients who do not have other apparent medical issues.

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A recent study found a higher prevalence of middle cerebral artery disease in patients with a lacunar infarct. The study also found that lacunar infracts in the deep white matter were associated with higher prevalences of occlusive carotid artery disease than in those without a carotid artery disease. Moreover, it was found that patients with a clinically silent lacunar infarct are more likely to develop a vascular disease, including CSVD.

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While CT scans are the most common imaging modality for lacunar infarct, MRI is the most accurate. It is particularly useful in determining if an infarct is chronic or acute, despite the fact that the T1-weighted and T2-weighted MRIs are not sensitive enough to distinguish between the two. Further, lacunes are characterized by focal areas of decreased signal intensity in T1 and T2-weighted images, while chronic lesions show isointensities in CSF.

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In addition to T2-weighted images, MRIs of the lacunae revealed a recent fibrin-platelet thrombus. The thrombosis also extended to the perforators. The patient's condition improved steadily, indicating that the infarction was caused by a vascular thrombus. If the infarction was caused by an occlusive artery, MRI imaging is an ideal way to confirm the diagnosis.

A lacunar infract may also be caused by a vascular problem that is affecting the small subcortical blood vessels. The occlusion of a deep penetrating artery causes brain infarction. If this occludes a blood vessel, it can cause a lacunar stroke. However, it is still important to understand that ischemic stroke is a serious vascular condition.

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A lacunar infract may be caused by a deep penetrating branch artery or a micro atheroma in a lenticulostriate branch. Other causes include vasculitis, embolism, and infection. While the exact causes of lacunar infarcts are unknown, this condition is frequently associated with vascular dementia. If a patient has had multiple episodes of a lacunar infract, he or she is likely suffering from vascular dementia. The condition may be symptomatic, with atypical features that are common to chronic infarctions.

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Fortunately, the treatment of lacunar infracts is similar to that of an ischemic stroke. The most important treatment is thrombolysis, which involves breaking up blood clots in the blood vessel through a mechanical device or medication. Lastly, a thrombectomy may be necessary to remove the blood clot and restore brain function. In both cases, patients are prescribed blood-thinning medications for 90 days after the lacunar infract.

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There is a low sensitivity of NCCT, which may not be sensitive enough to identify a lacunar infarct. FLAIR sequences and T2 imaging may not be sensitive enough to detect lacunar infarcts. However, DWI may be useful in patients who have small infarcts in the subcortical regions of the brain. Further, CTP and CBF measurements can help determine the underlying cause of a lacunar infarct.

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There are few studies that focus on risk factors for a lacunar infract in the deep white matter. Only one study compared baseline vascular risk factors with new infarcts. Researchers hypothesize that the two types of infarcts are caused by different etiologies. So, although new lacunar infarcts may be due to a distinct vascular risk factor profile, this does not mean that the risk of a basal infract is greater.

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Studies have shown that patients with first-ever lacunar infracts have an increased risk for developing a secondary condition called silent multiple lacunar infarctions. Patients with first-time lacunar infarcts are at risk for milder neuropsychological symptoms. In addition, the patients with a history of cognitive problems have decreased IQ scores. It is unclear if these are caused by the same underlying condition or a comorbidity.

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A diagnosis of a lacunar infract requires careful monitoring and testing to distinguish it from a cortical ischemic stroke. Further research is necessary to identify the exact underlying cause of the condition and devise effective secondary prevention regimens. The risk of lacunar stroke in the elderly is increasing in the United States, with more than half of the cases being associated with a previous stroke. If the diagnosis of lacunar infract is made without proper evaluation, the disease could lead to vascular dementia and other complications.

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