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  • Writer's pictureOren Zarif

Lacunar Stroke - Oren Zarif - Lacunar

Several risk factors are associated with lacunar stroke, including advanced age, smoking, diabetes, and alcohol consumption. Individuals with a history of stroke are also at risk. Carotid artery pathology can cause lacunar strokes. Atrial fibrillation is another risk factor. Although patients with this type of stroke typically recover, they may develop subcortical dementia and white matter damage. Because of the complexity of lacunar stroke, early detection is essential.

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Initial evaluation of a suspected lacunar stroke includes brain imaging, especially CT/MRI. CTA is not always helpful in diagnosing this condition because small perforating arteries are difficult to detect on this test. A CT or MRI may be helpful in ruling out other life-threatening conditions. The treatment for lacunar stroke is similar to that for acute ischemic stroke. The goal is to identify the underlying cause of symptoms and to determine whether it's the right treatment.

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A lacunar stroke damages a part of the brain called the thalamus. The stroke destroys this portion of the brain, resulting in motor and sensory impairment. The patient may experience a weakened arm or leg, or may even be unable to move at all. Most lacunar strokes are small, but they can still cause significant disabilities. They make up around 20 percent of strokes in the United States. This type of stroke should not be underestimated, however.

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People with lacunar strokes are at risk of developing more severe brain damage, especially if they have other types of stroke. Because the brain is so complex, the onset and treatment of lacunar stroke is crucial. Getting proper treatment immediately is essential to prevent permanent brain damage. Because the brain cannot function without proper blood flow, the brain cells die. Although lacunar stroke is rare, it can be life-threatening if left untreated.

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If the symptoms are present, a doctor will examine the patient to rule out other conditions. A CT scan is not useful in diagnosing lacunar stroke, but it may be used to rule out other causes of the symptoms. Another imaging test, CT angiography, is also helpful for identifying lacunar strokes, especially when they are new. This test is also known as the most accurate imaging method for lacunar stroke.

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The mechanism by which lacunes occur is controversial. Some researchers believe that they are the result of emboli originating from larger arteries or the heart. Although these hypotheses are speculative, there are clinical and epidemiologic reasons for separating lacunar stroke from other ischemic stroke types. However, it is still important to consider all participants as at-risk for cognitive impairment. So, how can we determine whether a patient is at risk for lacunar stroke?

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MRI scans show that microhaemorrhages are an additional risk factor for a lacunar ischaemic stroke. These microhaemorrhages may increase the risk of an intracerebral haemorrhage. Further studies on the mechanisms behind these lacunar ischaemic strokes are needed to identify the best secondary prevention strategy. The study of small arteriolar abnormalities may aid in identifying diagnostic and prognostic markers.

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The symptomatology of lacunar infarction varies from person to person. It is associated with valvular heart disease and diabetes. Symptoms may occur within minutes, but the condition may require months for full recovery. A lacunar infarction may also be due to cardioembolism. Cardioembolic stroke usually presents with gradual onset of focal neurological deficit. It is not uncommon for an infarction to manifest with sudden onset.

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A neurologist or internal medicine specialist may be needed to manage patients with a lacunar infarct. Medications to relieve the clots may be given orally to minimize the risk of another stroke. Intravenously administered medications may also be used to reduce the symptoms of lacunar infarcts. After the event, treatment of lacunar ischemia requires close coordination of care. If a patient has a history of vascular disease, they should be placed on aggressive antihypertensive medications and lipid-management.

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Patients with lacunar infarcts may develop severe hemiplegia. Clinical symptoms of lacunar infarcts vary depending on the area of the brain infected. A typical presentation of lacunar stroke is hemiplegia, but it can be associated with a wide range of other symptoms, including cerebellar dysfunction, dementia, and vascular stenosis. Patients with this type of stroke are likely to have multiple penetrating arteries, and therefore may have multiple lakes of infarct.

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MRI data from these studies have been analyzed for risk factors related to lacunes. The models included variables for aging, stenosis, and vascular disease. Although no single factor explains the risk of lacunes, age, and creatinine level are independent risk factors. These findings are consistent with those observed for single and silent lacunes. Among individuals with a single lacune, age, and a 50 percent stenosis in the internal carotid artery were associated with lacunes.

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