Lacunar Stroke - Oren Zarif - Lacunar

A lacunar stroke is a type of ischemic stroke that affects the brain's deep white matter. The strokes in this part of the brain occur in areas that control voluntary movements, such as the pons, the brainstem, and the basal ganglia. Because these regions are so important for motor and sensory functions, strokes in this area of the brain are associated with severe disabilities, including reduced mobility, gait, and balance.

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If a patient suspects that they may have a stroke, the doctor will ask about their medical history and check vital signs. An electrocardiogram may be ordered. Magnetic resonance imaging (MRI) scans can also be used to diagnose lacunar strokes. Diffusion weighted imaging is particularly sensitive in detecting this type of stroke. If there are no other symptoms, the doctor may suggest treatment with a different type of imaging test.

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Although lacunar stroke is uncommon, it is associated with significant morbidity and mortality. While it can be fatal, early diagnosis and treatment improve the odds of a favorable outcome. In this article, we review the pathophysiology of lacunar stroke and describe its symptoms. We also highlight the role of the interprofessional team in treatment. There are many different treatment options for lacunar stroke, and the importance of care coordination is discussed.

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There is a debate as to the mechanism of lacunar stroke. One theory suggests that emboli from the heart or larger arteries may cause them. However, this theory has yet to be proven. Larger clinical series have not shown causality, because they have been studied in only symptomatic patients. The lack of pathological material in some cases has led to an incorrect diagnosis. In addition, some clinical classification systems may have biased results.

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Other researchers have noted that the presence of a lacunar syndrome correlates with vascular risk factors. The TOAST classification has been associated with a greater risk for lacunar infarcts. Nevertheless, this correlation did not hold once age, sex, and number of lacunes were considered. The researchers concluded that the association between WMH volume and lacunar syndrome was not statistically significant. A study of lacunes and their symptoms suggests that some risk factors are more common in older patients than in other age groups.

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There are several causes of lacunar stroke. Microatheroma involving the lenticulostriate branch or a macroatheroma associated with a parent artery occlusion can lead to lacunar stroke. Other causes of this type of stroke include vasculitis, embolism, and infections. Vasospasm is unlikely to be the cause of lacunar infarct, and vascular dementia is frequently associated with repeated episodes.

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Despite its relatively low incidence, lacunar strokes are not common in patients. Affected patients may experience no symptoms at all. However, the symptoms can lead to significant physical and cognitive disabilities if more than one lacunar infarct occurs in a single patient. Although the exact cause is not fully understood, doctors can rule out several possible causes for lacunar strokes by using clinical judgment and radiologic imaging. The first step in preventing a lacunar infarct is identifying the artery that is causing the problem.

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A large study in the Cardiovascular Health Study (CHS) looked at 3660 elderly people who had undergone MRI. Among them, 1131 had ischemic infarcts, while 841 had lacunes. Interestingly, the majority of these individuals had no history of stroke, despite the fact that most of them did not report a previous stroke. Furthermore, many people with lacunes deny any history of stroke, thereby increasing the risk of a subsequent stroke.

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Although there are few studies of lacunar stroke, the results from this study show that patients with a single symptomatic lesion are more likely to survive than patients with multiple silent lesions. These findings also support the hypothesis that there are 2 types of lacunar stroke. Researchers are still working to identify which patients are most at risk for these disorders. The researchers suggest identifying these two types of lacunar stroke so that more research can be done on the risk factors associated with them.