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Lacunes and other holes: diagnosis, pathogenesis, therapy

G B Bradač1, D Daniele, M Bergui

  • 1Neuroscience-Neuroradiology Department, University of Turin; Turin, Italy - gianniboris.bradac@unito.it.

The Neuroradiology Journal
|November 22, 2013
PubMed

Insights

Lacunar ischemic lesions involve small perforating arteries, but large intracranial artery changes are increasingly recognized. Early diagnosis and neuroimaging are crucial for appropriate lacunar stroke treatment.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Lacunar ischemic lesions are associated with perforator artery pathology.
  • Causes include embolism, hypoperfusion, and proximal large artery occlusion.
  • Large intracranial artery disease is an emerging cause of lacunar strokes.

Purpose of the Study:

  • To highlight the role of large intracranial artery disease in lacunar stroke.
  • To emphasize the importance of comprehensive clinical and neuroradiological evaluation.
  • To discuss potential endovascular treatment options for selected cases.

Main Methods:

  • Review of clinical and neuroradiological findings in patients with lacunar syndrome.
  • Analysis of etiological factors, including large artery disease.
  • Consideration of differential diagnoses for lesions on CT/MR imaging.

Main Results:

  • Large intracranial artery disease is a significant factor in some lacunar strokes.
  • Advanced neuroimaging aids in identifying the cause and guiding therapy.
  • Distinguishing true ischemic lesions from other pathologies on imaging is critical.

Conclusions:

  • An integrated approach is necessary for diagnosing and managing lacunar stroke.
  • Endovascular therapies may be applicable for certain patients with large artery involvement.
  • Accurate differential diagnosis is essential to avoid misinterpreting imaging findings.

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