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  • Writer's pictureOren Zarif

Lacunar Infract - Oren Zarif - Lacunar Infarct


A doctor will first evaluate the condition by performing a neurological exam, taking blood pressure. Then they will perform a detailed examination of the brain. A heart function test may also be needed, as this is an early sign of a lacunar infarct. Early treatment of lacunar stroke can improve survival and limit further damage. Antiplatelet therapy and other measures to control vascular risk factors are often used to manage lacunar stroke.

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The mechanisms underlying lacunes are unclear. Some believe that emboli from the heart or larger arteries may cause the infarction. However, cross-sectional observational studies have not established causality. Other studies have dealt only with symptomatic patients. Despite the potential risk of developing lacunes, they are still a viable diagnosis. And because they have high mortality rates, lacunes may be less prevalent than other types of stroke.

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In the Cardiovascular Health Study, researchers analyzed 3660 patients with suspected lacunar infarct. Of those, 1131 showed ischemic infarcts and 841 showed lacunes. More than half of the patients had no history of stroke. Thus, they often fail to recognize a stroke despite its signs and symptoms. If lacunes are suspected, patients should be monitored closely and referred for appropriate treatment.

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There is still a need for studies to determine what factors increase the risk of lacunar infarct. However, certain groups are more susceptible to this type of stroke. Age is a significant factor, as is having a history of heart disease. Obstructive sleep apnea and high cholesterol can also increase the risk of lacunar infarction. In any case, emergency treatment is essential.

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A deep penetrating branch occlusion, a microatheroma of the lenticulostriate artery, and an arterial infarct caused by parent artery occlusion are among the causes of lacunar infarcts. Other causes of small cerebral infarcts include embolism, vasculitis, and infections. However, autopsy is not necessary to confirm the diagnosis of lacunar infarct.

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Several authors have reviewed the MRI findings in patients with lacunar infarct, including Dr. Tatemichi, Desmond, and Prohovnik. In addition, Schroth G and Schneider A studied the cognitive changes in patients without context following a lacunar infarct. These studies support the importance of multidisciplinary care in treating lacunar infarcts. And they demonstrate the importance of coordinating care.

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Lacunar infarcts are relatively common, accounting for 25 percent of all ischemic strokes. As small vascular lesions, lacunar stroke has a good prognosis in the early stages. However, as the stroke progresses, the risk of death due to cardiovascular causes increases. It is important to note that age, vascular risk factors, and cerebral small-vessel disease may all affect the prognosis of lacunar infarct. While the risk of another stroke is similar to that of other types, there is a higher risk of cognitive decline and dementia in patients with this condition.

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A multivariate analysis of MRI results showed that risk factors vary by the type of lacune. A higher systolic blood pressure and creatinine level were associated with a higher risk of developing lacunes, as did a greater number of pack-years of smoking. Age and gender were also significantly associated with lacunes. The presence of coronary heart disease at baseline and stenosis of at least 50% were associated with higher risk of developing lacunes.

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A recent study compared the CTP with NCCT/CTA in detecting lacunar infarcts. Researchers found that CTP had better sensitivity than NCCT/CTA for identifying lacunae. The researchers reviewed 1085 CTP examinations on patients who had acute stroke symptoms. They recorded patients with infarcts that were at least 2 cm in size based on NIHSS scores.

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Acute stroke caused by a blockage of the small arteries of the brain is called a lacunar infarct. The infarct arteries branch directly from larger arteries. Lacunar infarcts account for 15% to 25% of all strokes. They are associated with increased risk of vascular dementia and post-stroke cognitive decline. Early detection of lacunar infarct is important in limiting damage and recovery.

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