Definition and Overview

A lacunar infarction is a type of stroke that occurs when one of the small arteries of the brain is blocked. It is a small infarct (usually less than 20mm in size) that usually occurs in the distal distribution of the deep penetrating vessels. Also known as a lacunar stroke or lacunar cerebral infarction, it accounts for 25% of all ischemic strokes and about 1/5th of all strokes.

The condition affects the deepest structures of the brain. A person who suffers from it is at risk of permanent brain damage and has a significantly increased risk of subsequent strokes. Thus, it is crucial for patients to be promptly diagnosed and treated in order to prevent serious and irreversible damage to the brain. Effective and adequate long-term management is also necessary to prevent recurrences.

Causes of Condition

A lacunar infarction of the brain happens when one of the blood vessels in the brain is blocked, preventing blood from passing through properly. The lack of enough blood and oxygen supply to brain cells causes them to die.

Blockages in the arteries of the brain occur when cholesterol plaques or blot clot (thrombosis) form and get stuck in the artery. The risk of this happening is higher if patients meet some of the following factors:

  • Age - A person’s risk of lacunar stroke increases with age, with the mean age being 65 years.

  • Gender - Men are more likely to suffer from lacunar strokes than women.

  • Chronic high blood pressure

  • Heart problem

  • Diabetes

  • A family history of stroke

  • Excessive alcohol consumption

  • Drug abuse

  • Smoking

  • Exposure to secondhand smoke

  • Poor diet

  • High cholesterol levels

  • Obstructive sleep apnoea

  • Sedentary lifestyle

  • Birth control pills

Key Symptoms

Lacunar stroke symptoms include:

  • Slurred speech

  • Confusion

  • Memory problems

  • Numbness that affects only one side of the body

  • Difficulty walking

  • Difficulty moving or raising the arms

  • Difficulty speaking

  • Difficulty understanding speech

  • Loss of consciousness

  • Headaches

Patients who suffer from this condition can also enter into a coma.

The full range of lacunar infarct symptoms a person suffers from depends on the location of the blockage and which blood vessel is affected. These symptoms become more pronounced in the late acute or early subacute stages.

Patients who present with any of the above symptoms should get checked up immediately. Any type of stroke can be life-threatening and needs to be promptly diagnosed and treated. Patients who are suspected of having a stroke undergo immediate testing that will likely include the following:

  • Computed tomography (CT) scan

  • Magnetic resonance imaging (MRI) scan

  • Doppler ultrasound to measure blood flow in veins and arteries

  • Detailed neurological exam to check nerve pathways in the body

  • Heart function tests, such as electrocardiogram and echocardiogram

  • Kidney and liver function tests

Sometimes, however, a lacunar stroke may not cause any identifiable symptoms. This is called a silent lacunar infarction (SLI), which accounts for 10% of all silent strokes. Unless promptly treated, an SLI can cause severe damage to surrounding brain tissues, which can affect various aspects of a person’s personality, cognitive function, and mood.

Who to See and Types of Treatments Available

Patients who are suffering from lacunar stroke symptoms should be taken to an emergency room for immediate diagnosis and treatment. Once diagnosed and prompt lacunar infarct treatment is administered, the patient may be referred to an internal medicine specialist for long-term care.

In the emergency room, the patient is first given an aspirin to reduce the risk of another stroke, along with medications used to relieve blood clots. These may be given either orally or intravenously. If the patient’s condition is severe, the doctor may opt to deliver the medication directly into the brain for faster results.

The rate of a person’s recovery following a stroke differs depending on the severity of the damage to the brain’s structures. If the patient’s brain is severely damaged, he may not be able to care for himself for some time. He may also lose bodily strength and suffer from numbness, paralysis, or loss of muscle control to some extent. Due to this, patients usually need the following therapies to speed up their recovery:

Physiotherapy programs aim to aid in rehabilitation by improving the patient’s joint range of motion and stability. Patients may also require splints and braces to support their joints and limbs and to prevent further complications such as muscle spasms and contractures.

Stroke survivors also often have short-term memory problems and reasoning difficulties. It may be harder for them to control their emotions, making them more likely to suffer from depression. All of these factors need to be managed accordingly to ensure the long-term health and safety of the patient.

References:

  • Samuelsson M, Soderfeldt B, Olsson GB. “Functional outcome in patients with lacunar infarction.” Stroke. 1996;27:842-846. http://stroke.ahajournals.org/content/27/5/842

  • Caplan LR. “Lacunar infarction and small vessel disease: Pathology and pathophysiology.” J Stroke. 2015 Jan;17(1):2-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325635/

  • Agranoff AB. “Lacunar stroke.” Medscape. http://emedicine.medscape.com/article/322992-overview

  • Norrving B. “Lacunar infarction.” Stroke. 2004;35:1779-1780. http://stroke.ahajournals.org/content/35/7/1779

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