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Lacunar strokes: current concepts
1Department of Family and Community Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock 72205.
Insights
Lacunar strokes, often linked to hypertension, arise from blocked arteries in the brain. Advanced imaging helps diagnose these strokes, revealing diverse causes and presentations beyond classic syndromes.
Area of Science:
- Neurology
- Vascular Neurology
Background:
- Lacunar strokes are caused by occluded penetrating arteries in subcortical brain regions.
- They constitute approximately 19% of all strokes and are a common complication of chronic hypertension.
- Classic clinical syndromes include pure motor hemiparesis, pure sensory stroke, ataxic hemiparesis, and dysarthria-clumsy hand syndrome.
Purpose of the Study:
- To review the pathogenesis, clinical course, and diagnostic approaches to lacunar strokes.
- To highlight recent findings that expand the understanding of lacunar stroke causation and presentation.
Main Methods:
- Utilized computed tomography (CT) for antemortem study of lacunar disease.
- Reviewed recent literature on lacunar stroke etiology and clinical manifestations.
Main Results:
- Computed tomography has improved the study of lacunar strokes.
- Lacunar strokes can be embolic or hemorrhagic, not always linked to hypertension, and may present with atypical neurological signs.
- Some lacunar strokes can be larger than previously thought.
Conclusions:
- Lacunar strokes have diverse causes and presentations, some deviating from classic syndromes.
- Noninvasive diagnostic studies are crucial for accurate diagnosis, avoiding risks of anticoagulation or surgery.
- Early and accurate diagnosis using neuroimaging is key to appropriate patient management.
Abstract:
Lacunar strokes result from occlusion of penetrating arteries in the deeper, subcortical parts of the cerebrum and brain stem. Approximately 19 percent of all strokes are of the lacunar variety with lacunar strokes representing the most common cerebrovascular complication of chronic hypertension. Four major clinical syndromes are pure motor hemiparesis, pure sensory stroke, ataxic hemiparesis, and the dysarthria-clumsy hand syndrome. The advent of computed tomography (CT) has allowed the antemortem study of lacunar disease and has shed new light on the pathogenesis and clinical course of lacunar strokes. Recently, it has been demonstrated that lacunar strokes may be embolic or hemorrhagic in causation, are not invariably associated with hypertension, and may be larger and associated with hypertension, and may be larger and associated with neurological manifestations that do not conform to the classic patterns. In most instances, however, recognition of the characteristic clinical presentation and confirmation of the diagnosis with noninvasive studies spare many patients unnecessary risks associated with anticoagulation, arteriography, or vascular surgery.