Chronic Lacunar Infarct Treatment in Mumbai, India

Lacunar infarct, also called lacunar stroke, occurs when small arteries in the inner brain get blocked due to inadequate blood flow. These arteries are little and branched, making them highly vulnerable to blockages. Lacunar infarct is a type of ischemic stroke characterized by blockages in the blood vessels within the brain. 

Associated Anatomy

Inner regions of the brain

Chronic Lacunar Infarct Symptoms

Lacunar infarcts rarely show any specific symptoms. The symptoms depend upon the affected brain region. A lacunar stroke usually occurs suddenly without warning signs. Symptoms include:

• Ataxia: When one side of the body can’t coordinate with the other side
• Change in the senses, temperature, taste, or touch
• Impaired speech
• Weakness in the facial muscles
• Losing motor skills like raising your arm
• Confusion
• Decreasing memory power
• Recurring numbness
• Severe headaches
• State of unconsciousness or coma

Chronic Lacunar Infarct Causes

The following are the main causes of lacunar infarct:

• Fat deposition in the arteries causes atherosclerosis; artery blockage
• Lipohyalinosis: Thickening of deep blood vessels of the brain
• Family history of ischemic blood strokes
• Previously occurred ministrokes
• Nutrient deficit diet, especially Vitamin B12 and folate
• High levels of homocysteine in the bloodstream

Chronic Lacunar Infarct Typical Tests

Lacunar infarct is usually diagnosed accidentally when other conditions are being looked for in imaging techniques. If you are showing signs of lacunar infarct, then your doctor first asks you for a CT Scan. A CT scan is done to rule out all the similar potential conditions.

• After a CT Scan, a CT angiogram is done to confirm the lacunar stroke. A dye is injected into the bloodstream before the scan to detect the blockages. This is done to diagnose atherosclerosis.
• MRI: For better analysis and detail of the inner parts of the brain, MRI is done.

Chronic Lacunar Infarct Possible Treatment

Treatment for lacunar infarct is the same as ischemic strokes. Following are the treatment options for Lacunar infarct:

Chronic Lacunar Infarct Surgical Procedures

Thrombolysis: This involves using medications and mechanical medical devices to open the blockages of the arteries. It is usually performed as an initial treatment for less dangerous strokes, especially when symptoms last for less than 4.5 hours.

Thrombectomy: A surgical procedure performed to remove blood clots when symptoms last for more than 4.5 hours and less than 24 hours.

Medications after surgery: After performing the above-mentioned procedures, your doctor will prescribe you a blood-thinner for at least 3 months to prevent further blood clotting. You may also be put on medications for blood pressure, blood sugar, or any other prior health complications.

Post-surgery Therapies: Different types of therapies are given for several months after stroke for quick healing. The purpose of these therapies is to get you back in motion by improving your motor skills. Therapies include:

• Physical therapy
• Occupational therapy
• Speech and language therapy

Chronic Lacunar Infarct Risk Factors

Following are the reasons that can be a cause of Lacunar infarct:

• Diabetes
• Family history
• High cholesterol levels
• Blood pressure
• Smoking
• Earlier strokes
• Cardiovascular disorders
• Genetic disorders
• Excessive alcohol consumption
• Drug use
• Pregnancy-related complications
• Continues use of birth control pills
• Sedentary lifestyle
• Nutrient deficient diet
• Sleep apnea

Chronic Lacunar Infarct Complications

Lacunar strokes tend to generally happen in old age. Lacunar strokes are more likely to cause dementia in older patients. Multiple lacunar infarcts simultaneously cause physical and cognitive disabilities.

Chronic Lacunar Infarct Primary Prevention

Primary Prevention

Lacunar stroke can be life-threatening. Although we cannot rule out factors beyond our control like ageing and heredity, a good lifestyle can reduce the chances of a lacunar stroke to a very extent. Some of the most effective yet common preventive measures are as follows:

• Maintain a healthy weight
• Exercise for at least 30 mins a day
• Eat nutrient and vitamin-rich food
• Avoid smoking and drinking.
• Avoid living a sedentary life.
• Go for routine full body checkups every 6 months or annually and never ignore any signs and symptoms.

Secondary prevention

Secondary prevention includes therapies that are given after the first visible symptoms of lacunar stroke. It includes:

Antiplatelet monotherapy: it includes administering medicines aspirin, dipyridamole, clopidogrel, and cilostazol.

• Aspirin is most commonly administered as first-line medicine due to its inexpensive, high tolerance rate and capabilities to increase long-term adherence to therapies.

Statins and anticoagulants are also used. Epidemiology

• Generally, people older than 65 years are at a higher risk of developing lacunar stroke.
• Those who are already suffering from cardiovascular diseases and depression.
• 11% of the people are repeat patients of lacunar stroke.
• Recovery is fully possible in younger patients, but older people are left with some sort of disability.

Chronic Lacunar Infarct Prognosis

Expected Prognosis

The recovery rate of Lacunar infarct is higher than the other strokes affecting larger blood vessels. Although it's more common in older people, even after recovery, it left some sort of disability in the patient, especially those having cardiovascular disease or depression. Dementia is one of the most common after-effects. But, timely treatment can result in 100% recovery.

Natural progression

If a Lacunar stroke is left undetected or untreated even after developing signs and symptoms, it may lead to :

• paralysis in one side of the body
• numbness or loss of motor skills
• Short-term Memory loss
• Impaired speech and language
• Depression
• Cardiovascular diseases

Pathophysiology

• Strokes are the second largest cause of death globally.
• One-third of ischemic strokes are lacunar infarct.
• Lacunar stroke affects older people in general.
• Most are left disabled, with a loss of sensation.
• Paralysis and dementia are also common.
• Cardiovascular diseases and depression can also develop.

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