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  • Writer's pictureOren Zarif

Lacunar Infract - Oren Zarif - Lacunar Infarct

The presence of a lacunar infract on a CTP examination does not correlate with its size on DWI. This is because defects appear as regional abnormalities, larger than the location of a lacunar infract. A previous study by Rudilosso et al (15) noted a focal abnormality on CTP, but did not use a threshold. It is possible that the restricted diffusion may represent the "core" of the infarct, while abnormalities may be a wider zone of ischemia.

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Acute lacunar infarcts are typically located in the cerebral hemisphere with the highest WMH burden. These asymmetric lesions may be particularly susceptible to lacunar infarcts. The location of the lacunar infarct also determines the probability of a subsequent lacunar stroke. A lacunar infract may also be a sign of another condition, such as periventricular syndrome (PWS).

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The extent of the infarct depends on the location of the lesion and the underlying cause. Some studies report a close association between new lacunar infracts and cerebrovascular disease, while others say that they are distinct from small vessel disease. However, the risk factors vary between the two. The more common cause of lacunar infarcts is thrombo-embolic occlusion of the perforating arteries.

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Once a diagnosis is made, a doctor will take blood pressure and ask about symptoms. An extensive neurological examination may be conducted to determine whether the cause is an underlying disease. Medications may be prescribed to help manage muscle spasticity and prevent further damage. Pharmacists will help to monitor potential interactions between medications and increase the patient's chances of recovery. The primary care provider will also provide the patient with long-term care coordination. In addition to intensive antihypertensive therapy and lipid management, the doctor may prescribe aspirin to reduce the likelihood of stroke. Supportive measures such as blood sugar control may be needed.

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While lacunar infarcts in the deep white matter have similar risk factors as those in the basal ganglia, the risk for developing a new infarct is higher among patients with a history of cerebrovascular disease. The risk ratios were also higher after adjusting for age and baseline white matter hyperintensity volume. This suggests that there are distinct risk factors for both types of infarcts.

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While vascular risk factors such as hypertension and high cholesterol do increase the risk for a lacunar infarct, they are not correlated with a higher rate of the disorder. A higher BMI and a lower level of physical activity also increased the risk for a new infarct. Further research needs to be conducted to better understand the association between risk factors and lacunar infarcts.

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While a lacunar infract can result in various symptoms, they often depend on the brain region damaged. Each hemisphere controls different aspects of the body. The right hemisphere controls motor and sensory functions on the left side of the body. Conversely, the left hemisphere controls those functions on the right side. When one part of the brain is affected, the other hemisphere may be affected as well.

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Patients with a history of prior strokes are also at an increased risk of a lacunar infract. A history of previous strokes, diabetes, and hypertension are risk factors for lacunar infarctions. Acute lacunar infarctions can be fatal, but patients often recover. If they do, they may develop subcortical dementia. This may even result in permanent damage to the brain.

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While many people with a lacunar infract do not experience symptoms, the onset of dementia and cognitive decline can be devastating. A lacunar infract is the result of a blockage in a smaller artery. Because these arteries are not large, the stroke can be classified as a "minor" lacunar infarct. The cause of lacunar infarcts is unclear, but a common complication is a thickened lipohyalinosis.

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