Stroke refers to a group of diseases called acute cerebrovascular accidents (stroke).
What is lacunar ischemic cerebral stroke?
This is an acute violation of cerebral circulation, resulting from the blockage of small arteries that supply blood to the deep structures of the brain (basal nuclei, thalamus, internal capsule, bridge, cerebellum).
Lacunar stroke occupies about 20% of all types of ischemic stroke.
Intracerebral arteries are small-caliber arteries and have a small number of collaterals.
In these vessels with arterial hypertension, morphological changes occur, which ultimately lead to the development of lacunar stroke.
The mechanism considered above is called hypertonic. Many authors highlight the atherosclerotic mechanism. This mechanism has an indirect effect on the development of lacunar stroke, since the classic targets of atherosclerosis are arteries of large and medium caliber. Due to the defeat of large and medium arteries, changes occur in small arteries.
At the site of morphological changes in the artery, a focus of necrosis appears, followed by the formation of lacunae (cavities) in the deep parts of the brain. The size of the gaps varies from a few millimeters to 1,5 -2,0 cm. The detection of some lacunar strokes is possible only with the histological method of research. Giant cavities with a diameter of more than 2,0 cm are rare.
- Arterial hypertension;
- Transient ischemic attack;
- Coronary heart disease;
- Impaired lipid metabolism;
- Heart failure;
- Smoking and alcohol abuse.
Lacunar stroke often occurs during the day during physical and emotional stress, but night situations are also noted. Symptoms increase gradually over several hours, less often – days.
With this stroke, higher nervous activity is not disturbed. There are no cerebral symptoms (headache, depression of consciousness), epileptic seizures, hemianopsia (loss of half of the visual field), changes in electroencephalography (EEG).
In addition to a specific appearance, the lacunar form of a heart attack differs from other varieties of stroke by a number of specific signs. The first is the small size of the lesion. The magnitude of lacunar strokes is from 1 mm to 1,5-2 cm. Occasionally, larger sections of a heart attack (more than 2 cm) are found, which are called giant.
Often the disease is multiple. In one patient, from several tens to hundreds of cavities can be found, giving the patient’s brain the appearance of a cheese head. Usually this anatomical picture is observed in the elderly, patients with diabetes mellitus. Multiple organ damage is the cause of senile dementia (dementia), Parkinson’s disease, extensive hemorrhage, pseudobulbar symptom.
Single gaps are also found, most often in women, young people (3).
The appearance of lacunae is associated with damage to small intracerebral arteries, which pass deep in the middle of the brain. Pathological cavities form around the affected vessel; therefore, the organ cortex does not touch. Due to which higher functions (speech, memory, intelligence) are rarely affected, other symptoms may be mild. This is the main reason why the disease is not always able to be diagnosed during life.
There is no specific treatment for lacunar stroke. Doctors prescribe drugs to the patient that eliminate the main causes of heart attack:
- antihypertensives – normalize pressure;
- statins (atorvastatin, rosuvastatin, simvastatin) – lower cholesterol;
- nootropics (piracetam, cerebrolysin, cinnarizine) – stimulate mental activity, improve memory, learning ability, increase resistance;
- microcirculation correctors (Actovegin) – improve blood supply to the brain.
In addition to medical care for lacunar stroke, patients are recommended to work with a psychologist. During classes, the patient learns how to deal with stress and fear. The specialist tries to help the patient come to terms with the new status, changes his mood, and relieves psychological stress. Relatives are also advised to seek the advice of a psychologist to better understand the needs and problems of a loved one.
The auxiliary methods of treating lacunar infarction include:
- physiotherapeutic procedures;
For reference. If, with extensive ischemic or hemorrhagic strokes, bright specific clinical symptoms are observed, then the so-called “small” lacunar strokes are a significant difficulty in the initial diagnosis.
With a lacunar stroke, a slow progression of symptoms is often observed over several days, the absence of motor impairment, seizures, impaired consciousness, unilateral paralysis of facial muscles and other specific manifestations of strokes.
Despite a favorable prognosis for recovery and a low mortality rate (compared with extensive strokes), there is a significant risk of developing a repeated, more severe stroke within six months after a lacunar stroke.
Lacunar stroke is a small (small) in size cerebral infarction, usually affecting the periventricular region, thalamus or basal ganglia (80% of cases of lacunar stroke). In more rare cases, lacunar strokes of the brain stem or cerebellum are noted.
Almost all lacunar strokes (LI) have ischemic damage to brain tissue (of all cases of lacunar strokes, only 4% are hemorrhages in the brain tissue).
For reference. The magnitude of the lacunar stroke can range from a few millimeters to 1.5 centimeters. Lacunar foci in the brain with a diameter of 1.5-2 centimeters are extremely rare and are classified as giant LIs.
Lacunar stroke of the brain develops as a result of obstruction (obstruction) of the lumen of a small vessel with a thrombus, atherosclerotic plaque, embolus, etc. In this case, ischemia of a small part of the brain occurs with the development of a small necrotic cavity – lacunae.
For reference. Ischemic lacunae are always located deep in the brain tissue, so a small hemorrhage can also form around the main zone of necrosis.
In this case, the symptoms of lacunar stroke will be more pronounced. In lacunar strokes, cerebral arteries up to 80 microns in diameter are affected.
As a rule, these are perforating branches of the anterior, middle, posterior cerebral arteries, as well as the main artery.
Due to the fact that collateral blood flow is poorly developed in the basins of the branches of these arteries, their blockage leads to the formation of a small focus of a heart attack. In the future, as a result of necrotic changes, this focus softens with the formation of an ischemic gap.
The lack of vivid clinical symptoms in lacunar strokes is explained by:
- small size of the necrotic focus;
- the absence of a progressive zone of ischemia and severe metabolic disorders in the brain tissue;
- lack of cerebral edema and displacement (dislocation) of brain areas;
- preservation of the cerebral cortex due to the presence in it of a good collateral blood flow (thanks to a dense network of capillaries).
For reference. Single lacunar strokes are more characteristic of young patients suffering from arterial hypertension. In elderly patients, multiple lacunar strokes associated with atherosclerotic lesions of the cerebral vessels can occur.
- bleeding disorder;
- vascular hyalinosis;
- unstable lipid deposits (the initial stage of atherosclerosis) in the vascular wall;
- inflammatory lesions of the vascular walls and replacement of their muscle layer with connective tissue, etc.
According to the pathogenetic sign, LI is divided into atherosclerotic and hypertonic. However, in most cases, lacunar stroke is mixed.
In atherosclerotic LI, sclerotic vascular damage is arteriosclerosis and affects only small-caliber vessels. Therefore, this type of stroke can develop even in the early stages of cerebral arteriosclerosis in young patients. In this case, a spasm of blood vessels of the microvasculature will serve as a predisposing factor.
For reference. In case of hypertensive lacunar strokes, at the height of the hypertensive crisis, the microthrombus, part of the atherosclerotic plaque, fat embolus (unstable lipid plaques) are detached, etc., followed by obstruction of the brain vessel.
- decompensated diabetes mellitus, accompanied by damage to the vessels of the microvasculature;
- lipid imbalance with the formation of unstable lipid plaques in the vascular walls;
- blood coagulation disorders with the formation of microthrombi;
- alcohol abuse;
- congenital vascular pathologies;
- decompensated arterial hypertension;
- autoimmune diseases accompanied by damage to the vascular walls;
- frequent stress;
- chronic sleep deficiency and overwork;
- the presence of diseases accompanied by increased fragility of capillaries;
- hemorrhagic diathesis;
- hereditary predisposition.
According to the results of histological studies, lacunar strokes are divided into four histological types, which are accompanied by:
- obliteration, sclerosis and necrosis of the walls of the arteries around the center of the heart attack;
- specific amputation of an artery, blockage of which led to a heart attack;
- the development of several ischemic gaps located remotely from the clogged artery;
- the formation of several foci of a heart attack located in the clogged artery basin.
Acute cerebrovascular accident has many varieties. Most carry a potential hazard to the health and life of patients.
This is not about one disease, but about a large group. At the same time, most acute cerebrovascular insufficiency variants are potentially fatal.
Lacunar stroke is a pronounced malnutrition of cerebral structures at the level of special depressions and white matter of the brain.
Unlike other varieties of the pathological process, as such, there are no cerebral disturbances. There is no headache, no nausea, much less vomiting. Because the foci are small, they rarely reach more than a centimeter in diameter, although such cases are described.
The moment of occurrence of a stroke is also beyond description. Symptoms increase gradually, to say exactly when the violation developed, will not work. Often it forms at night and the patient is already waking up in this state.
Therapy is urgent, hospitalization in a neurological hospital is necessary. Lacunar infarction is a dual disease.
With the general mild course of the process, it is likely that problems will arise in the future. Complications include aneurysms of the deep arteries of the brain and possible hemorrhagic events (bleeding) in the future.
The development of the disease is based on a stable marked increase in blood pressure.
According to statistics, specialized studies, the pathological process is formed only in patients with hypertension.
Further, the process proceeds according to the classical scheme: acute ischemia (malnutrition) and the death of cerebral tissue sites.
At the same time, the size of the foci is minimal. However, single forms are extremely rare. More often there is a combined process. Hence the sluggish clinical picture, minimal symptoms, mainly of a neurological local nature. There are no cerebral signs.
The causes are typical for all forms of stroke with minor corrections:
- Arterial hypertension. In this case, plays the largest role. It is a key factor in the development of lacunar stroke. A distinctive feature of this type of process is the lack of a clear correlation between age and risk.
Numerous cases of the development of pathology in young people are described long before the onset of 30 years.
- Atherosclerosis. In the deep vessels of the gaps of white matter, cholesterol plaques are not deposited. This is another feature of this particular form of pathology. However, arteries can stenose, narrow.
A similar process is observed in patients with a long history of smoking, persons who abuse alcohol, drug addicts. Stenosis is difficult to eliminate on its own; medical care is required.
- Diabetes. Strictly speaking, in itself does not provoke a lacunar stroke and does not even participate in the mechanism of its formation in a direct way. It has an indirect effect. Because against the background of the course, secondary atherosclerosis develops.
- Arteritis. Inflammation of the vessel wall. It can be infectious or autoimmune (much less often). The disease itself is infrequent. Outside of high-quality treatment, arteries heal, the lumen narrows.
After suffering a lacunar stroke, restoration of cerebral trophism takes a long time. Unlike other localizations, in this formation of the secondary circulatory network occurs slowly. Then the inflammation is treated urgently, relapse and death of the patient are possible.
- Genetic abnormalities, congenital anomalies of blood vessels. Since we are talking about lacunar structures, they are not visible on MRI or CT. It is almost impossible to detect an anomaly.
- Thrombosis. The formation of blood clots. They clog arteries, violate trophism (nutrition), and lead to the death of nerve clusters.
Factors are used by specialists to detect the etiology of the process and to prescribe treatment that may affect the root cause.
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Lacunar ischemic stroke has a lot of flow options.
A key feature of the pathological process is extremely scarce symptoms, which is caused by a point lesion of individual cerebral structures.
In total, more than 10 types or syndromes or complexes are distinguished. More common are (with increasing: from the rarest to the most common).
- Most of the other cases are in the classic motor variety. Lacunar stroke of the brain is accompanied by paralysis of the limbs and the entire half of the body, opposite the location of the lesion.
Mimic muscles also suffer. There are no other neurological phenomena. This is the only symptom.
Paresis is possible – impaired sensitivity with almost completely intact motor activity.
- Sensual option. The patient loses the ability to tactfully recognize objects, phenomena, external stimuli. Pain, temperature reactions and other irritants are not perceived.
This is temporary, it lasts from several days to a couple of months. As part of rehabilitation, sensitivity is fully restored. A similar form occurs in 25% of patients.
- Hypotonic type. It is observed in 10-15% of clinical situations. Accompanied by a drop in muscle strength.
Muscles become flabby, contracting poorly, which makes movement and physical activity, if not impossible, then difficult.
On the one hand, paresis or paralysis is likely. Coordination deviates insignificantly from the norm, which is manifested in the course of special tests and standard neurological studies.
- Impaired coordination and partial paralysis. Deviation is manifested in several ways. There is an awkwardness in the hands, the inability to perform small precise movements.
Speech dysfunction is not uncommon: the structure of statements is correct and logical, but inhibition or fuzziness of articulation is possible. Due to lack of sensitivity and controllability of facial muscles, tongue.
Cases of paralysis of the neck are described, because the patient is not able to hold his head, arms and legs on one side. The incidence of dysarthria is 10% or less.
Other signs of a lacunar stroke of the brain are even less common:
- Parkinsonian. If extrapyramidal system suffers. Typical symptoms occur, the main one being muscle stiffness. The muscles are hypertonic, cramped, but weak. In this case, the patient is not able to move normally, quickly gets tired.
- Incontinence, peremptory urge to empty the hollow organ. Also, the only symptom of a pathological process in which it is difficult for even qualified doctors to suspect a sign of a stroke.
- Dyskinetic form. It is accompanied by muscle weakness while maintaining sensitivity and motor activity. Patients are forced to walk with small steps in order not to fall. Hand movements are sluggish, inaccurate, a person cannot keep an object on its weight.
The main symptoms are determined by a violation of the motor component. In this case, speech and the work of the sense organs do not suffer, the intellectual-mnestic component also.
The clinical picture develops gradually, over several hours, less often two days.
The exact moment is not clear. Often at night, the patient already wakes up with signs of acute cerebral blood flow disturbance.
The overall severity of the deviations is negligible when comparing the condition with other forms of stroke.
Lacunar infarction of the brain is confirmed in a hospital, it is impossible to do anything on an outpatient basis, the condition is difficult to evaluate. A specialized specialist is a neurologist.
The standard scheme of patients is as follows:
- Oral survey. With the safety of speech. If violations are observed, you need to talk with relatives. Typical complaints are recorded, the objectification of symptoms allows you to compile a complete clinical picture and compare it with known calculations. Put forward hypotheses.
- History taking. It plays an equally important role. It is necessary for a quick assessment of the likely etiology of the process. Arterial hypertension always occurs in patients.
- Measurement of pressure and heart rate. The first indicator is stably changed upwards, the second may be normal. Depends on the condition of the cardiac structures.
- Encephalography. Used to study brain activity in various areas. With a lacunar stroke, the signals from the outbreak weaken, but not significantly. The doctor should pay attention to any deviations, and not take them for an error.
- MRI diagnostics. Doesn’t make much sense even with contrast gadolinium amplification. However, with a sufficient size of the affected area, a focus of the hypo-intense signal is detected, which can be regarded as a verification (confirming) sign. In approximately 60% of cases, tomography does not produce any result.
- Dopplerography of cerebral vessels, duplex scanning. To >
As necessary, additional studies are prescribed. At the discretion of a specialist.
Therapy is strictly inpatient. At least in the first few days. To persistent correction of condition. Prescribed drugs of a number of pharmaceutical groups:
- Thrombolytics. In the first 4-8 hours from the onset of the pathological process. Fibrinolysin or streptokinase. Dissolves the formed blood clots. It does not allow hemodynamic disturbances to progress.
- Antiplatelet drugs. Prevent further development of blood clots. Aspirin-Cardio or Heparin, other names are possible.
- Fast acting diuretics. For example, Furosemide or osmotic diuretics – Mannitol in limited quantities. Medications prevent cerebral edema and possible lethal consequences against the background of this emergency condition. They are not suitable for long-term use, they have a negative effect on the heart and blood vessels.
- Cerebrovascular drugs. Normalize brain nutrition. Piracetam or Actovegin. The course of therapy with these agents is continued after the end of the acute period.
- Angioprotectors. Strengthen the walls of blood vessels, increase their elasticity. Names are selected by a specialist.
Symptoms of pathology
All symptoms of the pathological process are divided into two large groups:
- general clinical signs – specific manifestations of a stroke, according to which most patients can be diagnosed;
- disease syndromes – a typical combination of several disorders indicating the localization of the lesion.
Common clinical signs are:
- mandatory presence of arterial hypertension in a patient;
- usually, a lacunar stroke occurs in a dream, it is preceded by a headache, increased pressure;
- immediately during a stroke, blood pressure is normal/slightly increased, there is no headache/mild, drowsiness, lethargy, or loss of consciousness;
- speech, ability to read, count saved;
- deterioration occurs gradually over several hours/days, often accompanied by a temporary improvement.
|Name||Localization of the lesion|
|Purely motor stroke (50%) – paralysis of one half of the body||Inner capsule, bridge, sometimes radiant crown, brain leg, rarely – medulla oblongata|
|Purely sensitive stroke (5%) is a unilateral violation of all or most types of sensitivity: pain, temperature, tactile||Thalamus, less commonly the brain stem|
|Ataxic hemiparesis (10%) is an imbalance accompanied by dizziness only clockwise/counterclockwise. Accurate movements are poorly given to the patient||Bridge, inner capsule, brain stem|
|Sensitive-motor stroke (35%)||Thalamus or inner capsule, less often – radiant crown, bridge|
|Awkwardness in the hand and dysarthria are problems with targeted, accurate movements of the hand, speech impairment: a person is poorly given the pronunciation of individual sounds of words because of the inability to control the facial muscles.||Bridge, inner capsule|
|Hemichorea-hemiballism – uncontrolled unilateral waving of the arm, leg, head.||Lenticular nucleus, caudate nucleus|
|Isolated facial muscle paralysis – the lower part of the face is skewed on one side, the mobility of the forehead (the ability to frown, raise eyebrows) is usually preserved.||Radiant crown, inner capsule|
In some patients, a complete restoration of lost functions is observed, while in others, residual neurological disorders persist for the rest of their lives. However, this form of stroke is associated with a high risk of a repeated ischemic brain attack in the future. Most often, this disorder develops in people over 60 years old.
The lacunar type of heart attack got its name due to the peculiarities of changes in brain tissues observed against the background of this pathology.
Characteristic foci form in the deep tissues of the brain, including:
- in white matter;
- in the visual tubercle;
- in the inner capsule;
- in the waroline bridge;
- in the cerebellum.
At the same time, the cerebral cortex, which is responsible for thought processes, does not suffer. Due to cerebrovascular accident, foci form in the tissue structure, the size of which varies from 1 to 20 mm. Similar formations have a round or irregular shape. Against the background of these changes, microaneurysms can form, which in the future can provoke hemorrhages.
Depending on the nature of the disorders that occur against the background of damage to brain tissue, a lacunar insult can be of the following types:
The clinical manifestations of the disease and its prognosis largely depend on the type of stroke.
Causes of pathology
In most cases, the lacunar type of stroke is the result of a prolonged course in a patient with arterial hypertension. Frequent sudden surges in pressure and crises without directed therapy create the conditions for impaired cerebral circulation.
Another common cause of stroke is considered atherosclerosis of blood vessels. This violation is accompanied by the formation of cholesterol plaques. These formations first narrow the lumen of the vessels, slowing blood flow.
In the future, the vessels can be completely blocked. This leads to the fact that brain tissue begins to experience a deficiency of oxygen and nutrients. Because of this, the appearance of marked foci of tissue damage is observed.
Often the development of ischemic brain damage is observed against the background of diabetes mellitus, accompanied by severe violations of electrolyte and carbohydrate metabolism.
In addition, often ischemic damage to brain structures of this type is observed against the background of inflammatory damage to blood vessels caused by pathogenic microflora or allergic reactions.
There are a number of factors that affect the composition and coagulability of the blood and increase the risk of developing lacunar damage to the brain.
These factors include:
- extensive burns;
- dehydration of the body;
- vegetative-vascular dystonia;
- poor nutrition;
- long smoking history;
- pathological addiction to alcohol;
- work in hazardous industries;
- living in environmentally disadvantaged areas.
This ischemic damage to brain structures can occur against the background of a hereditary predisposition to such pathologies. People with close blood relatives suffering from a similar violation of cerebral circulation are at a special risk of its development.
Often a lacunar stroke of the brain proceeds without any clinical manifestations. Asymptomatic pathology is observed in about a third of patients. In other cases, the clinical signs of such a pathological condition as lacunar ischemic stroke depend on the type of its course.
The most common is an isolated motor variant of pathology, in which characteristic gaps form inside the bridge and capsule. This violation manifests itself with paralysis on the side opposite from the location of the gap. Sensory impairment is often present in only one limb or half of the face.
Isolated sensory stroke of the brain is somewhat less common. In this case, areas of damage appear in the ventral thalamic nerve node. A similar variant of the pathology course is found in most cases only in elderly people who have crossed the 70-year age limit.
Pathology can manifest itself with symptoms such as:
- the inability to recognize the temperature of surrounding objects;
- disorders of the musculo-articular apparatus;
- loss of touch.
With this variant of the course of the pathology, characteristic manifestations of the disease can be observed in the head, limbs and trunk. In this case, a quick recovery after a stroke occurs.
Relatively rare asthenic lacunar stroke of the brain. With this course, the following are observed:
- violation of coordination of movements;
- pyramidal disorders;
- decreased muscle tone of the limbs.
In the dysarthric variant, characteristic foci during magnetic resonance imaging (MRI) are determined in the area of the brain bridge. Such changes cause awkwardness with hand movements.
In addition, the development of a lacunar stroke can be accompanied by such manifestations as:
- frequent urge to urinate;
- urinary incontinence;
- violation of coordination of movements;
- forced walking in small steps;
- memory impairment.
More often lacunar strokes occur at night. Before a person goes to sleep, he may have complaints of pain in his head. The next morning, if a stroke develops, the patient has characteristic signs of brain damage. Moreover, this kind of pathology is not accompanied by impaired consciousness, vision and speech, because it does not affect the cerebral cortex.
If there are signs of a stroke, the patient needs to consult a neurologist. In addition, a cardiologist and a number of other narrowly focused specialists may need to be examined. First, the doctor collects an anamnesis and conducts an external examination and neurological tests.
To clarify the diagnosis, the following studies are often performed:
- general and biochemical blood tests;
- transcranial dopplerography;
- CT scan;
After a comprehensive examination, treatment can be prescribed.
Therapy of lacunar stroke is carried out by conservative methods. First of all, drugs are selected that allow to stabilize the cardiovascular system and suppress the activity of the primary pathology, which caused ischemic damage to brain tissue. In addition, drugs are prescribed to help eliminate symptoms and reduce the risk of a second stroke.
The treatment regimen may include:
- means for eliminating arterial hypertension;
- antiplatelet agents;
To reduce the risk of re-stroke, high doses of Aspirin may be recommended to patients. In addition, the patient needs to normalize the mode of work and rest, devoting at least 8-9 hours to a night’s sleep. It is advisable to sleep in the afternoon.
You need to quit smoking and avoid stressful situations.
For quick recovery, the patient must follow a diet. In this pathological condition, table No. 10 is recommended. This diet involves the exclusion of sweet, spicy, fatty, salty and fried foods, as well as alcohol and coffee.
In the presence of motor disorders, a course of massage and exercise therapy can be indicated as part of rehabilitation.
There are a number of rules, compliance with which reduces the risk of developing lacunar stroke. People over 35 need to give up all bad habits.
Be sure to adhere to the rules of a healthy diet, including low-fat meats and fish, as well as vegetables and fruits, in the diet. Regular exercise is also important. To reduce the risk of stroke, it is recommended that you often go outdoors. Be sure to monitor the weight and prevent the appearance of extra pounds.
It is necessary to undergo scheduled examinations. In the presence of high blood pressure, you need to take drugs to normalize it. Some patients require medication to prevent the appearance of atherosclerotic plaques and blood clots.
After a stroke, cavities filled with fluids form in the brain. Such formations pose a threat to life and do not cause additional neurological disorders. At the same time, people who in the past suffered a stroke of this type are likely to relapse.
A large number of syndromes that occur during lacunar stroke have been described, but 5 of the most specific are distinguished.
|Syndrome name||Clinical characteristics|
|Motor stroke||Hemiparesis (a decrease in motor activity in the left or right half of the body with damage to the opposite hemisphere of the brain) without sensitive, visual disturbances and disorders of higher nervous activity.|
|Sensory stroke||Hemigipesthesia (decreased sensitivity on the one hand) without motor impairment.|
|Sensorimotor stroke||The combination of hemiparesis and hemigipesthesia.|
|Atactic hemiparesis||Severe weakness impaired coordination in the same limbs, most often in the leg.|
|Dysarthria is an awkward hand||The combination of dysarthria (speech impairment) and awkwardness in the hand.|
The above neurological syndromes may occur separately, or may be combined.
Diagnosis, treatment of lacunar stroke
In order to determine the lacunar ischemic stroke in the Yusupov hospital, such modern diagnostic methods as computed and magnetic resonance imaging are used, which are the most informative in this situation. With the help of these studies, the localization, number and volumes of formed gaps are revealed.
The usual research methods – computed, magnetic resonance imaging are not always able to detect lacunar ischemic stroke of the brain, especially with a tiny size of lesions (less than 1 mm).
An experienced neurologist makes a diagnosis, localization of the lesion according to typical pathology markers:
- characteristic clinical picture, medical history;
- MRI does not reveal pathology, although the symptoms clearly correspond to a stroke. On the 7th day of the disease, lesions can be visualized;
- deviation-free angiography;
- the level of cerebrospinal fluid enzymes (creatine kinase, angiotensin converting, lactate dehydrogenase) is normal.
In the diagnosis of LI, the main role belongs to:
- history taking;
- biochemical, general blood tests;
- modern methods of examining the brain (CT, MRI).
The greatest amount of information about the features of the course of the disease allows to obtain CT and MRI. These diagnostic methods help to accurately determine the number of lacunae, their size and area of formation. In the event that the patient has small voids, it is difficult to make an accurate diagnosis the first time.
|Blood circulation enhancers in the brain||Cavinton|
|Medications Preventing Brain Neuron Damage||Cerebrolysin|
|Products with Combined Properties||Thiocetam|
In parallel with the main therapy, a special diet will be required. Patients who have had a lacunar stroke should limit their intake of animal foods, legumes, foods high in carbohydrates, fried and greasy foods, sweets, and pastries. Instead of this product, preference should be given to cereals, boiled chicken and beef meat, fresh fruits.
To undergo a successful recovery from a lacunar stroke, patients often need to be in the clinic. About 25% of people who received basic treatment undergo rehabilitation under the supervision of medical personnel in specially designed institutions. In other cases, patients manage to recover on an outpatient basis (if all the doctor’s recommendations are followed).
Under favorable circumstances, the clinical manifestations of LI disappear within 3-6 months. If for some reason a successful recovery did not take place, the disease can reappear, provoke memory loss, complete spatial and social disorientation.
Forecast and Possible Consequences
Long-term observations suggest that lacunar ischemic stroke of the brain leads to the development of parkinsonism, and after years – dementia, otherwise called vascular dementia. These pathologies are manifested by memory lapses, the patient’s lack of ability to analyze the situation, the patient may forget to go home, disorient in space, stop monitoring his appearance, and become depressed.
Rehabilitation in the Yusupov hospital involves a whole range of activities: medical, social and psychological in nature. They are aimed at restoring the functions lost after a stroke. Highly qualified doctors of the hospital: neurologists, physiotherapists, psychotherapists have extensive practical experience in the field of restorative medicine, in their arsenal – the world’s leading methods, modern medical equipment and the latest drugs for treating the consequences of brain disasters, thanks to which it is possible to achieve high results. The clinic provides services for transporting patients to the hospital. Call by phone and the doctor-coordinator will answer all your questions.
The principles of rehabilitation: the duration of treatment, perseverance, early start, the complexity of methods, the active participation of the patient.
The rehabilitation plan requires an individual approach to each patient.
Actively restore the motor functions that are necessary to return the patient to an independent life. The restoration of functions can be carried out by several methods: therapeutic physical culture (exercise therapy), electrical stimulation, biological feedback method.
Exercise therapy is the most affordable recovery method. This method allows you to gain strength, as well as the volume of active movements in the affected limbs. Restoring strength and muscle tone in the future will help a person to sit, stand, walk, maintain balance and restore self-care skills.
Particular attention must be paid to restoring the functions of the brush. To do this, you need to apply a brush massage (improves blood circulation) and special hand simulators.
Electrical stimulation – this method is based on the impact of pulsed currents of a certain frequency. As a result, blood circulation improves, muscle strength and tone in the affected limbs are restored.
Recovery of speech disorders. With the restoration of this function, a speech therapist helps with the help of special techniques and training.
Psychological assistance is most needed for people of working age. In this situation, a great responsibility lies with relatives, who must ensure a favorable environment in the family and at home. In some situations, it is necessary to resort to the help of a therapist. Classes with a specialist give a good result. The use of drugs (sedatives, anticonvulsants), if necessary.
In the absence of adequate and timely therapy, as well as with repeated strokes, lacunar dementia occurs. Dementia is manifested by a deterioration in memory, a loss of orientation in space, irritability and impulsivity, and the loss of practical skills.
Of all forms of acute cerebrovascular accident with persistent symptoms, patients with lacunar stroke have the best prognosis. Death directly from the attack itself is extremely rare. According to a global study, only 3,5% of patients die in the first 1,78 years (4). The worst forecast are:
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Higher medical education. Kirov State Medical Academy (KSMA). The local therapist.
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Last Updated: October 18, 2019
General information about lacunar ischemic stroke
Lacunar ischemic stroke leads to pathological disorders in the deep layers of the brain and the formation of so-called lacunae (cavities), the diameter of which is from one to fifteen millimeters. Sometimes the lacunae merge, resulting in the formation of large cavities filled with blood or plasma and fibrin.
With this pathology, consciousness, vision, speech of the patient, other functions of the cerebral cortex are practically not disturbed, basically, also remain unchanged. In addition, symptoms of brain stem damage are also completely absent. Thanks to these distinctive features, lacunar stroke can be differentiated with other types of this pathology.
In the absence of qualified neurological care, this type of cerebral catastrophe threatens with the development of serious complications, even death. According to statistics, after patients have suffered a lacunar ischemic stroke of the brain, the prognosis of survival is: in the first month – 70-80%, during the year – about 50%. Therefore, a vital role belongs to the early diagnosis of pathology.
If the patient is diagnosed with a single lacunar stroke of the brain, the prognosis is favorable. As a rule, after rehabilitation, the patient has a restoration of all functions, although sometimes the presence of sensitive residual and motor symptoms may be observed.
With relapse, a lacunar state of the brain may develop, and the risk of this complication is very high: according to statistics, after a second lesion, this occurs in almost 70% of cases.