Lacunar strokes and infarcts: a review

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.