Lacunar Strokes: Can They Recur?

Lacunar strokes are life-threatening and can be fatal. They are caused by a blockage in the small arteries deep within the brain, interrupting blood flow. As a result, brain cells are deprived of oxygen and begin to die within minutes. While some lacunar strokes may not show any symptoms, others can lead to physical or cognitive disabilities. Those who experience a lacunar stroke are more likely to have another one and are at a higher risk of developing dementia and cardiovascular disease.

Lacunar strokes are a type of ischemic stroke

Lacunar strokes are relatively common, representing about one-fifth of all strokes. However, they often do not cause symptoms and may only be detected on brain scans. When symptoms do occur, they usually come on suddenly and can include weakness or paralysis on one side of the face and body, slurred speech, loss of muscle control, sudden loss of balance, and blurred or double vision.

The treatment for a lacunar stroke is similar to that of other ischemic strokes. It involves restoring blood flow to the brain as quickly as possible to reduce the risk of permanent brain damage and death. This may include thrombolytic therapy to dissolve clots or mechanical thrombectomy to remove clots. Blood-thinning drugs may also be used to prevent further clots from forming.

The risk of having a lacunar stroke increases with age and certain underlying health conditions, such as high blood pressure, heart disorders, diabetes, atherosclerosis, and peripheral artery disease. Additionally, genetic factors and lifestyle choices, such as smoking, excessive alcohol consumption, and a sedentary lifestyle, can also increase the risk of lacunar strokes.

While the prognosis for lacunar strokes is generally better than for other types of strokes, they can still lead to an increased risk of further strokes, dementia, and death from cardiovascular causes. Therefore, regular medical care and management of risk factors are crucial for recovery and preventing recurrent strokes.

They occur when a blood clot blocks a small blood vessel in the brain

Lacunar strokes occur when a blood clot blocks a small blood vessel in the brain. These blood vessels are very small and branch off directly from a larger artery, making them particularly vulnerable to blockages. Lacunar strokes are a type of ischemic stroke, which occurs when blood flow to the brain is interrupted.

Lacunar strokes are caused by a blockage in one of the small arteries that provide blood to the brain's deep structures. These arteries are uniquely vulnerable because, unlike most arteries, they do not gradually taper to a smaller size. Instead, they branch directly off of a large, high-pressure, heavily muscled main artery. This means that high blood pressure can directly damage these small arteries and cause them to become blocked.

High blood pressure is the most serious risk factor for lacunar strokes. It can lead to atherosclerosis, a condition where fatty deposits build up along the walls of blood vessels, narrowing the arteries and making blockages more likely. High blood pressure can also cause a pounding pulse that directly damages the small arteries.

Lacunar strokes can cause a range of symptoms, including weakness or paralysis on one side of the face and body, trouble speaking or loss of speech, slurred speech, loss of muscle control on one side of the face, sudden loss of vision or changes in vision, loss of coordination, and dizziness.

Lacunar strokes are life-threatening medical emergencies that require immediate treatment. The sooner a person receives a diagnosis and treatment, the more likely they are to survive. Treatment for lacunar strokes focuses on restoring blood flow to the brain as quickly as possible to reduce the risk of permanent brain damage and death.

Risk factors include high blood pressure, high cholesterol, and smoking

Lacunar strokes are life-threatening and are caused by a blockage in the blood flow to the small arteries deep within the brain. This blockage is often a blood clot.

The most significant risk factor for the development of lacunar strokes is chronic high blood pressure. High blood pressure causes the arteries to narrow, making it easier for cholesterol plaques or blood clots to block blood flow to the brain. Other risk factors include:

• High cholesterol (hyperlipidemia)
• Atherosclerosis (hardened arteries)
• Smoking
• Diabetes
• Genetic factors
• Age
• Alcohol use disorder

High blood pressure is the most serious risk factor for lacunar strokes. If you know you have high blood pressure, talk to a healthcare provider about managing it. They can help you get it to a safe level and keep it there.

Symptoms include weakness or paralysis on one side of the body, loss of muscle control, and slurred speech

A lacunar stroke is a life-threatening medical emergency that occurs when a blood clot blocks a small blood vessel in the deeper portions of the brain. It is a type of ischemic stroke. Lacunar strokes account for about one-fifth of all strokes and can be fatal.

Symptoms of a lacunar stroke include weakness or paralysis on one side of the body, loss of muscle control, and slurred speech. Here is a more detailed breakdown of these symptoms:

• Weakness or Paralysis on One Side of the Body: This is a common symptom of a lacunar stroke and can affect the face, arm, and leg. It is caused by disruptions in the brain, spinal cord, or nerves that connect to the affected muscles. The affected side of the body may not have the same strength level as the opposite side due to a problem in the brain or spinal cord.
• Loss of Muscle Control: Lacunar strokes can result in a loss of muscle control on one side of the face, making it difficult to control the tongue, voice box, or jaw. This may also cause difficulties with swallowing.
• Slurred Speech: Damage to the nervous system can cause the muscles involved in speech production to become paralysed or weakened, leading to slurred speech or dysarthria. This is a motor speech disorder that affects the tongue, voice box, or jaw, making it challenging for others to understand your speech.

It is important to note that not all lacunar strokes exhibit symptoms, and they are often discovered during imaging tests performed for other reasons. However, when symptoms do occur, they can include a combination of the above-mentioned issues, as well as difficulty walking or moving arms, inability to raise one arm, drooping on one side of the face, numbness on one side of the body, and difficulty speaking or understanding speech.

Treatment includes medication, surgery, and rehabilitation

Lacunar strokes are life-threatening and require immediate medical attention. Treatment for a lacunar stroke includes medication, surgery, and rehabilitation.

Medication

If you are experiencing symptoms of a lacunar stroke, doctors will evaluate you, likely in an emergency room. They will assess your symptoms and order a CT scan to rule out other conditions with similar symptoms, such as bleeding in the brain. They may also perform a CT angiogram, where dye is injected into your blood vessels to help identify them in the scan.

If your symptoms have been present for less than 4.5 hours, doctors may perform thrombolysis, a procedure that uses medication or a mechanical device to break up blood clots. If your symptoms have lasted longer than 4.5 hours but less than 24 hours, doctors may perform a thrombectomy, which is surgery to remove blood clots.

After either of these procedures, doctors will likely prescribe blood-thinning drugs to prevent more clots from forming. Additionally, medication may be prescribed to help manage cholesterol, blood pressure, and blood sugar levels to reduce the risk of another stroke.

Surgery

If the blockage is recent and the brain tissue is still viable, surgery may be performed to remove the blockage. This is known as a mechanical thrombectomy. During this procedure, a surgeon will insert a small, thin tube (a catheter) into a blood vessel and guide it to the clot in the brain. They will then either vacuum up the clot in one piece or break it apart and remove the pieces. However, it is important to note that this procedure cannot be used for lacunar strokes as the affected arteries are too small.

Rehabilitation

Following the initial treatment, rehabilitation is crucial to help the patient recover and maximize their independence. This may include:

• Occupational therapy: This helps patients maximize their independence with daily activities such as eating, bathing, and performing household tasks. Occupational therapists may recommend adaptive tools to help patients compensate for their deficits and achieve their goals.
• Physical therapy: This is essential to improve motor-related issues after a lacunar stroke. Physical therapists provide exercises to help stimulate neuroplasticity and retrain affected muscles.
• Speech-language therapy: Many survivors of lacunar strokes experience dysarthria (difficulty speaking due to trouble controlling oral-motor muscles). Speech-language pathologists provide exercises to help improve speech and swallowing difficulties.

Frequently asked questions