NeurologyDes 10; 81 infagtopp: Typically, tissue plasminogen activator may be administered within three to four-and-a-half hours of stroke onset if the patient is without contraindications i. You can change the settings or obtain more information by clicking here. Lacunar stroke — Wikipedia May Learn how and when to remove this template message. Cases and figures Imaging differential diagnosis. The onset of symptoms is often over hours or days.
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It is marked by hemiparesis or hemiplegia that typically affects the face, arm, or leg of the side of the body opposite the location of the infarct. Dysarthria , dysphagia , and transient sensory symptoms may also be present. Ataxic hemiparesis second most frequent lacunar syndrome posterior limb of the internal capsule , basilar part of pons , and corona radiata , red nucleus, lentiform nucleus, SCA infarcts, ACA infarcts It displays a combination of cerebellar and motor symptoms, including weakness and clumsiness, on the ipsilateral side of the body.
The onset of symptoms is often over hours or days. Pure sensory stroke contralateral thalamus VPL , internal capsule, corona radiata, midbrain Marked by numbness loss of sensation on one side of the body; can later develop tingling, pain, burning, or another unpleasant sensation on one side of the body. Mixed sensorimotor stroke thalamus and adjacent posterior internal capsule , lateral pons This lacunar syndrome involves hemiparesis or hemiplegia weakness with sensory impairment in the contralateral side.
Silent lacunar infarction[ edit ] A silent lacunar infarction SLI is one type of silent stroke which usually shows no identifiable outward symptoms, and is thus termed "silent. This type of stroke often causes lesions in the surrounding brain tissue that are visibly detected via neuroimaging techniques such as MRI and computed axial tomography CT scan. Silent strokes, including silent lacunar infarctions, have been shown to be much more common than previously thought, with an estimated prevalence rate of eleven million per year in the United States.
A SLI or any type of silent stroke places an individual at greater risk for future major stroke. According to Koffler et al. These lesions are less common within other brain regions such as the cerebellum , cerebral white matter and anterior limb of the internal capsule. Occasionally, atheroma in the parent artery blocks the orifice of the penetrating artery luminal atheroma , or atheroma involves the origin of the penetrating artery junctional atheroma. Alternatively, hypoperfusion is believed to be the mechanism when there is stenosis of the penetrating artery.
When no evidence of small vessel disease is found on histologic examination, an embolic cause is assumed, either artery-to-artery embolism or cardioembolism. More recent advances have also suggested these mechanisms may play a combined role in the aetiology of lacunar infarction.
The most current theory indicates endothelial dysfunction and increased permeability of the blood-brain barrier first allow leakage of blood contents, promoting gliosis and white matter hyper-intensities on magnetic resonance imaging.
Moreover, focal narrowing of brain vessels and impairment of their ability to dilate in response to various stimuli may lead to a decreased cerebral blood flow and ultimately lacunar stroke. It is unclear whether there is an association with alcohol consumption, elevated cholesterol, or history of prior stroke. Lacunar strokes may result from carotid artery pathology or microemboli from the heart as in atrial fibrillation. Patients often recover well, but if there is enough white matter disease from lacunar pathology, one can see a subcortical dementia such as Binswanger disease.
Treatment and prognosis[ edit ] Typically, tissue plasminogen activator may be administered within three to four-and-a-half hours of stroke onset if the patient is without contraindications i. High dose aspirin can be given within 48 hours. For long term prevention of recurrence, medical regimens are typically aimed towards correcting the underlying risk factors for lacunar infarcts such as hypertension, diabetes mellitus and cigarette smoking.
Anticoagulants such as heparin and warfarin have shown no benefit over aspirin with regards to five year survival. A physiotherapy program will improve joint range of motion of the paretic limb using passive range of motion exercises. When increases in activity are tolerated, and stability improvements are made, patients will progress from rolling to side-lying, to standing with progressions to prone , quadruped , bridging, long-sitting and kneeling for example and learn to transfer safely from their bed to a chair or from a wheel chair to a car for example.
Assistance and ambulation aids are used as required as the patient begins walking and lessened as function increases. Furthermore, splints and braces can be used to support limbs and joints to prevent or treat complications such as contractures and spasticity.
Continuing follow-up with a physician is essential so that the physician may monitor medication dosage and risk factors. Journal of the Neurological Sciences. Archives of Neurology.
Koffler, Sandra,, Mahone, E. Mark ,, Marcopulos, Bernice A. New York, NY. J Stroke, 17 1 , 2—6. JAMA Neurology, 1—9. Clinical Neurology and Neurosurgery.
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