Lacunar Stroke Detection - Oren Zarif - Lacunar
Several tests can detect lacunar strokes. A CT scan will take detailed images of the brain. Magnetic resonance imaging, or MRI, is an alternative test used to detect these strokes. In young, healthy individuals without apparent medical problems, a CT angiography may be necessary. This test can reveal blood vessel blockages, which are common in lacunar strokes. If a CT angiography shows no blockages, a more detailed workup may be necessary.
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A small chronic cavity is present in a large proportion of patients with a lacunar stroke. The location of the infarction is often unspecific, but can be representative of an embolic source. However, this type of stroke is associated with significant morbidity and mortality. Studies on patients who have suffered from a lacunar stroke have not found definitive causes. Researchers are still investigating the mechanisms that lead to these strokes.
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A subset of patients who have a lacunar stroke tend to have a better outcome over time than those with a single symptomatic lacunar stroke. This study found that patients with a single symptomatic lacunar stroke had a better prognosis than those with a single silent lacunar stroke. While the causes of these differences are not completely clear, it seems that a family history of a stroke could increase the risk. Similarly, a physical exam can detect health problems that increase stroke risk, such as high cholesterol and obstructive sleep apnea. All patients should seek emergency treatment for any type of stroke, including lacunar.
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A recent study by the University of Cambridge in the UK has given a team of scientists PS1 million to find out whether genetic factors are associated with a higher risk of lacunar strokes. Researchers will examine the DNA of 5,000 patients with lacunar strokes and look for genes that increase the risk of developing the disease. If successful, this study could reveal the mechanism behind this disease and lead to better treatments for lacunar strokes.
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Despite the fact that MRI scans can reveal an infarction, a lacunar stroke is more likely to be silent. The reason for this is that a clot may form in a vein in the neck or heart and travel through the bloodstream to the brain. An embolus, a blood clot that has failed to travel through the artery, may not be able to reach the brain.
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The MRI findings show that the prognosis of both single and multiple lacunar infarcts is different. This could be attributed to the distinct etiology of the two types of stroke. Although lacunar infarcts are usually thought of as a single entity, studies should focus on cognitive impairment to help differentiate the types of the disease. This would help in the design of future studies. The MRI images of brain tumors would help distinguish between the two.
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Another type of lacunar stroke is a mixed-sensory stroke. This is the most common type, with the most severe symptoms associated with mixed sensory and motor disorders. A stroke in this area may result in inability to move the arm or leg. The face is rarely affected. Therefore, diagnosis is important to determine the underlying cause. Once this diagnosis is confirmed, treatment will be similar to that of acute ischemic stroke. The patient's condition will depend on the specific type of stroke.
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A study of MRI findings of patients with ischemic stroke found that more than one in four individuals with lacunar infarcts also had a history of cerebrovascular disease. Smoking and elevated cholesterol levels were not associated with lacunar infarcts. However, MRI-defined lacunes are often silent and can go undetected in healthy adults. Therefore, further research is necessary to determine whether the presence of lacunes is predictive of future stroke.
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A stroke in the deep portions of the brain is called a lacunar stroke. The arteries to the deep brain are small and branch off of a larger, higher-pressure artery. The main artery in the brain is heavily muscled, causing high blood pressure, which directly damages the arteries. Another risk factor is atherosclerosis, which causes fatty deposits to build on the blood vessel walls. A lacunar stroke can cause substantial cognitive and physical disability.
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MRI is the best imaging modality for detecting lacunar infarcts. Its diffusion-weighted imaging helps distinguish between acute and chronic infarctions. MRI imaging of lacunes reveals focal areas of reduced signal intensity on T1-weighted images. Chronic lesions, on the other hand, are isointensity to CSF. These findings suggest a connection between the two.