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Lacunar Infarct

Definition

These are small areas of dead tissue deep within your brain and are known as lacunar strokes. An infarct is any tissue that has died because of not receiving oxygen normally caused by some problem with the flow of blood. A lacunar infarct can measure from 0.2 – 15 millimeters in diameter.


What is a Lacunar stroke?

This is also known as a lacunar infarct and though they are generally small when comparing them to other strokes these type of strokes account for approximately twenty percent of all ischemic strokes, which are caused by a blood clot. This is especially true in people who are suffering from diabetes or high blood pressure. These strokes are not typically fatal but they can result in brain damage and other disabilities that are similar to the larger strokes that are life threatening. Approximately fifteen per one hundred thousand people suffer from this type of stroke each year.

The type of damage that a person can suffer from having a lacunar stroke has five classifications, which are referred to as syndromes. With each syndrome, there are a specific set of symptoms.

  • Pure motor stroke – this one is the most common and accounts for as much as thirty-three to fifty percent of all lacunar infarcts and typically affect your face, leg, or arm on one side.
  • Ataxic hemiparesis – this is the second most common and is caused by a reduction or lack of motor control that can appear from hours to days after a person has suffered a lacunar infarct and usually affects the leg more than the arm.
  • Dysarthria clumsy-hand – this is the third most common and is similar to ataxic hemiparesis and is thought to be a variant of it
  • Pure sensory stroke – this type affects the sensations of pain, touch, pressure, vision, temperature, hearing, and taste
  • Mixed sensory stroke

Types of Lacunar infarctions

  • Acute lacunar infarct – this is when the lacunar infarct happens within one to seven days
  • Chronic lacunar infarct – this is when the lacunar infarct happens greater than a month
  • Basal ganglia lacunar infarct – this is a disruption of blood flow in the smaller arteries located in the white matter of your cerebral cortex. Some patients may experience this type of lacunar infarct one to three months after they seem to have recovered from a fungal, viral, or bacterial infection. Approximately twenty percent of all adult lacunar infarcts are generally located in the basal ganglia, which is a group of basal nuclei that lies deep within your forebrain. When a person has this type of infarct they suffer from severe headaches, vomiting, nausea, and eventually loss of consciousness along with speech abnormalities, facial drooping, and paralysis on one side of their body. They may also experience personality changes, and difficulty with concentration and comprehension.
  • Silent lacunar infarct – this one does not show any identifiable outward symptoms and many times a person is unaware that they have suffered a lacunar infarction. It is thought to have an approximate prevalence rate of eleven million cases each year in the United States.

Symptoms of Lacunar Infarct

Some of the general symptoms of a lacunar stroke, which can happen suddenly and without warning can include:

  • Slurred speech
  • The inability to raise one arm
  • One side of the face appears to drop
  • Numbness on one side of the body
  • Difficulty walking
  • Difficulty moving the arms
  • Struggling to speak or understand what someone is saying
  • Headaches may occur

If not treated these lacunar stroke symptoms can lead to a coma or loss of unconsciousness.

Syndrome symptoms

  • Pure motor lacunar stroke – paralyzed or severe weakness on one side of the body, difficulties speaking and swallowing
  • Ataxic hemiparesis – clumsiness, wobbliness, and weakness on one side of their body in the arm or leg with the face not being involved
  • Dysarthria – clumsiness or weakness in one hand, and is more prominent when a person is writing and disorder of speech (dysarthria). It is defined as difficulty forming or pronouncing words to the inadequate movements in your voice box and other muscles in your mouth.
  • Pure sensory stroke – numbness, burning, tingling, and other unusual and unpleasant sensations on the side of the body that is affected such as the arm, leg, thorax, anus, genitals, and face. It can also affect your fingers, your mouth on one side, or the foot.
  • Mixed sensory stroke – paralyzed or weakness in a body part like a pure motor stroke along with the sensory symptoms that are associated with a pure sensory stroke on one side of the body

In the sensory strokes, the sensory symptoms can come and go or be continuous with unpredictable intervals and varying levels of severity. In the ataxic hemiparesis, the symptoms can happen over hours or days.

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Causes

These types of strokes are normally caused by an obstruction or blockages in the smaller branches of your major arteries that supply deep brain structures. It can also happen after a person has suffered a silent cerebral infarction, which is an injury that causes a blood clot to interrupt the flow of blood to the brain. It can also be caused by:

  • Atherosclerosis – plaque buildup on the artery walls
  • Carotid artery disease – plaque buildup on the carotid arteries
  • Atrial fibrillation – irregular heartbeat that causes your blood to pool and clot

Many of the deep brain organs that are injured help to coordinate complicated body movements and communication between the brain cortex and brainstem so this is why you see speech and movement symptoms more often.

Risk factors

As you age the risk of having a lacunar stroke increases and men tend to have more strokes than women have. Other risk factors can include:

  • Smoking
  • Alcohol
  • Pregnancy
  • Using birth control pills
  • Drug abuse
  • Sedentary lifestyle
  • People with a family history of stroke
  • Chronic high blood pressure
  • Diabetes
  • Heart disorders
  • African-Americans
  • Hispanic
  • Unhealthy, poor diet

Treatment

At this time, there is no specific medical treatment for lacunar infarct. Treatment can include taking measures to prevent another from happening and physical rehabilitation. Your physician may give you intravenous or oral clot-busting medication. While in the hospital, you may need help with your heart function and breathing. Your physician can also use a catheter and deliver medication directly into your brain. You may also be put on a regimen of an aspirin, a blood-thinning medication, or both. You should also start exercising and eating a healthy diet that includes plenty of vegetables and fruits along with losing weight if you are overweight.

Prognosis

People who have experienced lacunar infarctions do seem to recover more completely and quicker than those who have had other strokes. As many as eighty percent of those who have suffered a lacunar infarction are able to function independently in twelve months compared to approximately fifty percent of those that have had another stroke. People who have suffered a lacunar stroke have a greater chance of surviving past thirty days (ninety-six percent) than those with other strokes (eighty-five percent).

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