Lacunar infarction: causes, symptoms and treatment

This type of stroke is one of the most common causes of brain injury.

Cerebrovascular accidents (CVA) consist of an interruption of the blood flow sent to the brain due to various causes. When this flow is stopped, the brain is no longer supplied with oxygen and nutrients, leading to damage or death of brain cells in a particular area of the brain.

But there are different types of stroke, usually these attacks damage the brain tissue of the outermost or superficial area of the brain. However, when this damage occurs in the innermost structures of the brain, it is referred to as a lacunar infarction.. This type of alteration will be discussed in the following lines.

What is a lacunar infarction?

Lacunar infarction refers to a type of stroke in which one of the arteries supplying blood to structures within the brain becomes blocked. one of the arteries supplying blood to the internal structures of the brain becomes blocked, leaving the brain without the oxygen and nutrients it needs to function.The arteries susceptible to damage in a lacunar infarction are the arteries that supply the brain with the oxygen and nutrients it needs to function.

The arteries susceptible to damage in a lacunar infarction are smaller and therefore more fragile than the rest, they come directly from a main artery which transports blood under high pressure.

When a person suffers a lacunar infarction, cells in a relatively limited area of the brain begin to be damaged or die from lack of oxygen. from lack of oxygen. Considering that a large number of internal brain structures cooperate in communication and coordination of body movements, a lacunar infarction can pose a significant risk of disability.

Compared to all other types of strokes, lacunar infarcts account for 20% of all strokes suffered by individuals.

Symptoms of lacunar infarction

Since different brain areas control various functions such as movement, vision, speech, etc., the symptoms that alert a person that he or she is suffering a lacunar infarction will depend on the area of the brain that is being damaged. These symptoms include:

• Weakening or paralysis in the face, arm, leg or foot
• Weakening or paralysis of the eye muscles
• Sudden muscle numbness
• Movement problems
• Speech problems

If a person suffering from high Blood Pressure does not receive any type of treatment, it is very likely that he or she will suffer a series of lacunar infarctions that will result in the appearance of additional symptoms such as dementia or emotional behavior.

Also, if the person notices one or more of the above symptoms they should be alert, as this could also mean that they are on the verge of a more serious cardiovascular accident.

Types of lacunar syndromes

As mentioned above, both symptoms and consequences can vary depending on the area of the brain affected by the lacunar infarct.

There are five main lacunar syndromes, out of a list of approximately 85, as follows.

1. Pure motor syndrome

In this type of lacunar accident the person experiences a paralysis or decrease of muscular vigor that affects equally to all a side of the body. This paralysis is called hemiparesis and affects approximately 50% of people who have suffered a lacunar infarction.

2. Ataxic hemiparesis

This consequence is characterized by a partial paralysis, or paresis, of variable severity and a great difficulty in the coordination of movements. a great difficulty in the coordination of movements, or ataxiaataxia, or ataxia, of the extremities, with the legs being more often affected than the arms.

3. Hand clumsiness and dysarthria

In this case the person suffers a decrease in the dexterity and precision of hand movements. In addition, this deficit is accompanied by difficulties in this deficit is accompanied by difficulties in articulating sounds or words caused by a weakness or caused by facial muscle weakness or paralysis, also known as dysarthria.

4. Pure sensory syndrome

In pure sensory syndrome, the person experiences continuous or transient numbness on one side of the body.. Also, you may suffer alterations in sensitivity that cause discomfort such as pain or a burning sensation in the affected part of the body.

5. Sensory-motor syndrome

The person who suffers from sensory-motor syndrome due to lacunar infarction suffers from a mixture of hemiparesis and hemiplegia symptoms.. These symptoms include decreased strength on one side of the body, along with paralysis and sensory impairment, all on the same side of the body.

Causes and risk factors.

There are a number of diseases and conditions associated with the occurrence of lacunar infarcts. Some of the most significant causes are:

Hypertension problems.

This is the most common cause. The fragility of the arteries of lacunar infarcts carry a very high risk for people with very high blood pressure.

Diabetes

Deterioration of the veins due to diabetes constitutes a risk factor for the person to suffer one of these infarctions.

Cardiac conditions

Diseases such as ischemic heart disease and atrial fibrillation are two major causes of lacunar infarction.

In addition, other risk factors that predispose people to suffer at some point a lacunar infarction are:

• Sedentary lifestyle
• Unhealthy diet
• High cholesterol levels
• Smoking
• Consumption of alcoholic beverages
• Drug abuse
• Sleep apnea
• Pregnancy

Treatment and prognosis

An emergency intervention in a person who has just had a lacunar infarct increases the chances of surviving the accident and, in addition, of minimizing its impact.

If detected and intervened within three hours of the onset of symptoms, anticoagulant drugs should be sufficient to improve blood circulation. However, if the infarction is more severe or takes longer to act, it will be necessary to inject the drugs directly into the affected area of the brain.

Usually, people who have suffered a lacunar infarction require general rehabilitation which includes the following aspects:

• Physiotherapy sessions to restore motor skills
• Neuropsychological rehabilitation to promote cognitive functions.
• Occupational therapy to facilitate the patient's daily life.
• Speech therapy intervention in the case of language impairment
• Psychological therapy to work on the emotional aspects of the consequences of the infarction. *** Pharmacological therapy** to eliminate the underlying causes of the lacunar accident

A diferencia de otros accidentes cerebrovasculares de mayor envergadura, el infarto lacunar se asocia a un mayor índice de recuperación, presentando mejorías en las horas o días siguientes al infarto.

Referencias bibliográficas:

• Bamford, J.; Sandercock, P.; Jones, L.; Warlow, C. (1987). The natural history of lacunar infarction: The Oxfordshire Community Stroke Project. Stroke. 18 (3): pp. 545 - 551.
• Grau-Olivares, M.; Arboix, A.; Bartrés-Faz, D.; Junqué, C. (2007). Neuropsychological abnormalities associated with lacunar infarction. Journal of the Neurological Sciences. 257(1–2): pp. 160 - 165.
• Sacco, S.; Marini, C.; Totaro, R.; Russo, T.; Cerone, D.; Carolei, A. (2006). "A population-based study of the incidence and prognosis of lacunar stroke". Neurology. 66 (9): pp. 1335 - 1338.