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Lacunar syndromes, often linked to hypertension, may be caused by normal pressure hydrocephalus, not just lacunes. Antihypertensive therapy effectively reduces the incidence of cerebral lacunes.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Lacunar syndromes are recognized by distinct clinical features, frequently occurring in hypertensive patients.
- Lacunes result from lipohyalinosis (small) or atheromatous/embolic occlusion (large) of penetrating vessels.
- The traditional understanding of the 'lacunar state' is being re-evaluated.
Purpose of the Study:
- To critically examine the concept of the 'lacunar state' based on current knowledge.
- To investigate the primary cause of clinical deficits attributed to lacunes.
- To assess the symptomatic nature of initial lacunes and the impact of antihypertensive therapy.
Main Methods:
- Review of clinical features of lacunar syndromes.
- Analysis of etiological factors for lacunes (lipohyalinosis, atheroma, embolism).
- Evaluation of the relationship between lacunes, normal pressure hydrocephalus, and clinical deficits.
Main Results:
- Clinical deficits in the 'lacunar state' are primarily linked to unrecognized normal pressure hydrocephalus.
- The occurrence of lacunes is not haphazard, with the first or single lacune often being symptomatic.
- A decline in cerebral lacunes incidence has been observed following antihypertensive therapy.
Conclusions:
- The primary driver of clinical deficits in the lacunar state appears to be normal pressure hydrocephalus.
- Targeted antihypertensive treatment demonstrates efficacy in reducing the incidence of cerebral lacunes.
- Further research is needed to fully elucidate the interplay between lacunes, hydrocephalus, and neurological deficits.
Abstract:
At least 20 different lacunar syndromes have been described and can be recognized by characteristic clinical features. Almost all occur in patients with hypertension. Small lacunes are usually due to lipohyalinosis, larger ones to atheromatous or embolic occlusion of a penetrating vessel. The concept of the "lacunar state" is examined in the light of recent knowledge with the conclusion that the clinical deficit is primarily related to unrecognized normal pressure hydrocephalus rather than to the presence of a few lacunes. The notion that lacunes occur haphazardly is criticized because the first or only lacune tends to be symptomatic. The incidence of cerebral lacunes has declined since the introduction of antihypertensive therapy, an indication that therapy is effective.