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It is a form of stroke which occurs due to the blockage of a penetrating artery that controls the blood supply to the deep structures of the brain. These strokes are believed to responsible for around 25% of the total cases of ischemic strokes. Most of the existing information about Lacunar Stroke has been derived from the cadaver dissections of several post-mortem stroke patients by renowned neurologist Charles Miller Fisher. Occlusion or blockage of one deep penetrating artery arising directly from the components of Circle of Willis basilar artery and cerebellar arteries causes Lacunar Infarct. Carotid artery pathology from the heart, like in Atrial Fibrillation, can also lead to LACS.
The two proposed mechanisms responsible for LACS are known as microatheroma and lipohyalinosis.
The association of this disorder with factors like elevated cholesterol, alcohol consumption and a history of stroke have not yet been explained in any way.
This form is characterized by Hemiplegia or Hemiparesis that usually affects the arm, leg and face of one side. It is marked by several motor and cerebellar symptoms such as clumsiness and weakness on the affected side of the patient’s body. Dysarthria, clumsiness and weakness of the affected hand are the most common symptoms of this form.
In this form of Lacunar Infarct, the patient experiences transient or persistent numbness, pain, tingling and burning sensations on one side of his or her body. Its symptoms include Hemiplegia or Hemiparesis along with an ipsilateral sensory impairment. Silent Lacunar Infarction (SLI) is a kind of silent stroke that does not generally cause any noticeable symptoms. A doctor studies the detailed medical record of the patient to see if he or she has a history of heart disease, high blood pressure, smoking, diabetes and high cholesterol. CT (computed tomography) scan and MRI (magnetic resonance imaging) of the brain are sometimes done for identifying Lacunar Strokes.
The differential diagnosis of this condition should ideally be done using dilated VRS or Virchow Robin spaces.
In most cases, patients start to recover within a few hours after receiving the initial treatment. Regular exercise, eating lots of vegetables and fruits as well as avoiding foods rich in cholesterol and saturated fats help in preventing the disorder. Jaundice is a liver disease in which the liver fails to convert the bilirubin of the blood properly. An individual is said to have Lacunar Stroke Syndrome or LACS if he or she is experiencing its symptoms but has not undergone the diagnostic imaging procedures. Many “lacunes” (‘empty space’ in Latin) were observed by him in the deep structures of the brain after the occlusion of 200 to 800 micrometer penetrating arteries which connected them with five classic syndromes.
This results in lesions in the brain’s deep nuclei (10% caudate, 14% thalamus and 37% putamen) and the internal capsule’s posterior limb (10%) or the pons (16%).

People with this type of stroke are usually completely unaware that they have the condition.
Although they do not cause any visible symptoms, SLIs affect the personality, mood and cognitive functioning of the patients. The vital signs of the patient, including pulse, breathing rate, temperature and blood pressure, are also checked. Diffusion Weighted Imaging, a specific MRI technique, is very useful for detecting these infarctions at an early stage.
In some instances, the presentation of intracranial hemorrhages and cortical infarcts can mimic the symptoms of Lacunar Infarcts. If the treatment begins within 3 hours after the onset of the symptoms, the doctors are likely to apply a tissue plasminogen activator or clot-dissolving medication for initial treatment. The treatment mainly aims to correct the underlying causes of the strokes, such as diabetes mellitus, hypertension and cigarette smoking, to reduce their recurrence chances. Physiotherapy programs help to improve the paretic limb’s range of motion by various passive exercises of range of motion. The patient is then observed by the doctor to find out whether the symptoms are getting worse. It has a better recovery rate compared to many other types of strokes involving the larger blood vessels. However, controlling the mentioned risk factors can help one to reduce the chances of developing Lacunar Strokes.
It is important to give up smoking for reducing the risks of developing this kind of Infarction.
However, the Silent Lacunar Infarctions cannot be detected at an early stage as they display no symptoms.
It would result in the increase in the level of bilirubin in blood causing inflammation of liver. In some infants, the antibodies of the mother would kill the red blood cells by mistake causing haemolysis. One is premature jaundice which affects the unborn babies that can halt the growth of the fetus and can be fatal. Phototherapy treatment is given to the newborn to decrease the level of bilirubin in blood. Lacunar Infarcts involving the thalamus are known as Thalamic Lacunar Infarcts while those affecting the pons are called Pontine Lacunar Infarcts. Currently however, microatheroma is considered to be the mechanism which most frequently leads to arterial occlusion (stenosis). In some rare cases, the infarctions occur in the deep cerebral white matter, the cerebellum and the anterior limb of the internal capsule. These strokes are often referred to as old Lacunar Infarction as they generally go unnoticed in the early stages. Individuals suffering from an SLI are at greater risk of developing a major stroke in future.
However, the true signs of cortical infarct (including visual field defects and aphasia) never occur in these types of strokes.

Blood-thinning medications like Warfarin and Heparin are often used for treating strokes in the large arteries.
More than 90% of the total patients recover substantially within 3 months of suffering from the stroke for the first time. Treatment helps the patients to roll in a side-lying position, to stand and to transfer safely from one position to another (e.g.
The diet and medication intake should be modified according to the recommendations of a doctor if a person has a history of heart disorders and blood pressure. Jaundice can occur due to hormone deficiency like very low secretion of pituitary glands or thyroid glands. The second type of jaundice is breast milk jaundice in which there are antibodies of the mother which increases the level of bilirubin in the blood of the baby.
In some cases, blood transfer is done to the newborn baby for lowering the level of bilirubin. People of Mexican, Hong Kong Chinese and African descent have greater risk of developing this condition. Fisher are still observed at present; although, the diagnosis of this condition depends on the radiologic imaging and clinical judgment of the physician. In some cases, when the parent artery develops an atheroma it blocks the opening of penetrating artery.
However, the cerebral surface, visual radiations and corpus callosum are not generally affected by the condition. In the hospital, physical therapists and occupational therapists work together to help the patients cope with their disability and to regain some strength after suffering from the brain injury. Acute Lacunar Infarcts has a higher recovery rate compared to the chronic form as they are generally diagnosed at an earlier stage.
These lesions can be detected through different neuroimaging techniques including CAT (Computerized Axial Tomography) scan and MRI. Generally, patients need to stay in a rehabilitation center for some time after being discharged from the hospital for receiving some additional intensive therapy. Sometimes, atheroma can also develop at the point of origin of the penetrating artery (junctional atheroma).
If any of the above symptoms are present, then the parent should contact the doctor without any delay. The mechanism of hypoperfusion is occasionally believed to cause stenosis of penetrating artery as well.
If the histologic examination does not show any evidence of the small vessel disease, the cause of the condition is believed to be associated with cardio-embolism or artery-to-artery embolism.
A recent study shows that 25% of the total patients, in whom various radiological tests show defined lacunes, had developed the stroke due to potential cardiac causes.

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