Information on Lacunar stroke

                                                                                         

Lacunar stroke occurs when one of the small arteries (diameter: 0.2 － 15mm) that provides blood to the brain's deep structures is blocked and injures deeper structures underneath the cortex. It may be referred to as a Lacunar Infarct (LACI). A patient who presents with the clinical symptoms of a lacunar stroke, but who has not yet had diagnostic imaging performed may be described as suffering from Lacunar Stroke Syndrome (LACS).

A lacunar stroke is a blockage of blood flow to a part of the brain supplied by one or more small arteries. In a lacunar stroke, a blood clot (thrombus) blocks blood flow. Lacunar strokes , a subtype of ischemic stroke, have earned their name because the area rendered ischemic takes the form of a small lacune or cavity (usually less than 15mm in diameter).

Unlike most arteries that gradually taper to a smaller size, the arteries of a lacunar stroke branch directly off of a large, high pressure, heavily muscled main artery. A much larger infarct may actually produce a less extensive (or intrusive) neurologic deficit for the patient Lacunar strokes account for about 20 percent of all strokes in the United States.

A lacunar stroke is a blockage of blood flow to a part of the brain supplied by one or more small arteries. These arteries are 0.1 to 0.3 millimeters in diameter. They branch from larger arteries near the underside of the brain, and carry blood to the brain's deeper regions, such as the thalamus, basal ganglia and pons. In a lacunar stroke, a blood clot (thrombus) blocks blood flow.

The lacunar hypothesis proposes that (1) symptomatic lacunes present with distinctive lacunar syndromes and (2) a lacune is due to occlusion of a single deep penetrating artery generated by a specific vascular pathology. This concept is controversial because different definitions of lacunes have been used. Lacunes may be confused with other empty spaces, such as enlarged perivascular (Virchow-Robbins) spaces, in which the specific small vessel pathology occasionally is absent. Originally, lacunes were defined pathologically, but lacunes now are diagnosed on clinical and radiological grounds. This problem is compounded by the present inability to image a single penetrating artery.

A true lacunar stroke is just like any other stroke in that you would expect sudden onset of neurologic problems. Such problems typically include weakness or numbness on one side of the body, trouble producing language (either slurred speech or trouble producing what you want to say) or trouble with understanding language, and visual loss or double vision. Because lacunar strokes are smaller, patients with this type of stroke are more likely to recover to some extent when compared to patients who have large strokes, although the extent of recovery is not predictable. Age and severity of stroke are the biggest predictors of recovery--younger ages and smaller strokes do better.

Lacunar strokes tend to occur in patients with diabetes, hyperlipidemia, smoking or chronic hypertension and may be clinically silent or present as pure motor hemiparesis, pure sensory loss, or a variety of well-defined syndromes (e.g., dysarthria-clumsy hand, ataxic-hemiparesis). Descending compact white matter tracts or brainstem gray matter nuclei are injured, often producing widespread and striking initial deficits. However, the prognosis for recovery with lacunar stroke is better than with large artery territory stroke, and for this reason many centers favor using antiplatelet therapy (aspirin, clopidogrel) or conservative management rather than thrombolytic therapy for uncomplicated lacunar stroke.


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