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Lacunar Stroke - Oren Zarif - Lacunar
The mechanism of lacunar stroke is not fully understood. Emboli from the larger arteries and heart may cause them, but a study of a small number of cases suggests the possibility of an embolic source for lacunar strokes. Despite the lack of definitive research, the mechanism has remained controversial. Various causes, such as atrial fibrilation, are suspected. In this article, we will discuss some common causes, and discuss their possible treatments.
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The first step in diagnosis is a visit to the emergency room, where doctors can evaluate your symptoms and order a CT scan. While not specifically designed to diagnose stroke, this test is helpful in ruling out other conditions. A CT scan shows the blood vessels in the brain, where blockages can occur. A magnetic resonance imaging scan, or MRI, is another test that can be used to identify lacunar strokes. The diffusion-weighted imaging is particularly sensitive in the detection of these cases.
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MRI-defined lacunar infarcts are common in healthy elderly adults. The most common risk factors are age, diastolic blood pressure, and creatinine, but differences among subgroups are not large enough to suggest different mechanisms. The presence of MRI-defined lacunes in older adults is not associated with a higher risk of stroke than in healthy young adults.
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However, subjects with MRI-defined lacunes are at greater risk of cognitive dysfunction and stroke in both the upper and lower extremities. Further research is needed to determine the role of lacunes as indicators of subsequent risk of stroke.
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Patients with lacunar infarcts should be evaluated for occlusive carotid artery disease. Other risk factors include an underlying CSVD. Patients with CSVD should also be evaluated for previous strokes, as a history of cerebrovascular disease may be a contributor to the development of lacunar infarcts. While there is no single cause of lacunar stroke, the risk of cognitive impairment should be considered by clinicians.
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There are several ways to improve research on lacunar stroke. One of these is to increase the sample size and follow-up period. A larger sample size is essential because statistical power is higher with larger numbers. One possible solution to this is the creation of an international database containing all patients. Meta VCI Map consortium and the PLORAS database could be used to collect data on lacunar stroke patients. Using multiple cognitive tests may make comparisons difficult.
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Symptomatic patients with a vascular dementia may experience a lacunar stroke. In symptomatic patients, a lacunar stroke can be a precursor of vascular dementia. The patient may experience multiple episodes of lacunar infarction over time. However, it is important to rule out other etiologies of ischemic stroke. When lacunar stroke is diagnosed, the patient should be evaluated with a complete physical examination and neurological tests.
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The study also identified patients who developed new infarcts in the white matter of the brain. Interestingly, the risk of new lacunar infarcts was higher among patients with vascular stenosis. After adjusting for age, sex, and the use of antihypertensive agents, the risk of new lacunar infarcts was increased by almost two-thirds in patients with deep white matter infarcts.
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Although patients with single symptomatic lacunar stroke are more likely to survive the condition, those with multiple lesions have a more poor prognosis. Patients with multiple silent lacunar lesions, however, have the lowest prognosis and functional outcome of all lacunar stroke cases. And patients who have more than one silent lacunar lesion have an increased risk of developing dementia. But this is far from a perfect diagnosis of lacunar stroke.
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Because lacunar strokes affect small blood vessels in the brain, symptoms are not always present. While patients with symptomatic stroke may be able to function well after undergoing treatment, they will likely require more than one session of therapy to recover fully. While there are few signs of lacunar stroke, the death of brain cells can disrupt bodily functions and result in significant disability. If left untreated, a lacunar stroke can cause a significant physical and cognitive disability.
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