Lacunar Infarction

Lacunar infarcts, small deep infarcts that result from occlusion of a penetrating artery, account for about a quarter of all ischaemic strokes the concurrence of both stroke types makes it difficult indeed to conceptualize a difference in the pathogeneses of these two main subtypes of (?ischemic) stroke. However, the exclusive role of hypertension and diabetes in the genesis of lacunar infarction has been questioned,as these risk factors are not present in all the patients. The risk of recurrent stroke after lacunar infarct is similar to that for most other types of stroke, and patients have an increased risk of developing cognitive decline and dementia. Thus, approximately one-third of survivors were dependent to some extent on other persons at 1 year; the investigators noted that this is a proportion similar to survivors of other types of stroke in the OCSP experience and emphasized that lacunar infarcts occur in "strategically important areas." This may have significant implications for the management of patients with lacunar-sized infarctions.

Lacunar infarcts are associated with poorly controlled hypertension or diabetes and have been found in several clinical syndromes, including contralateral pure motor or pure sensory deficit, ipsilateral ataxia with crural paresis, and dysarthria with clumsiness of the hand. The neurologic deficit may progress over 24–36 hours before stabilizing. Lacunar infarcts are sometimes visible on CT scans as small, punched-out, hypodense areas, but in other patients no abnormality is seen. In some instances, patients with a clinical syndrome suggestive of lacunar infarction are found on CT scanning to have a severe hemispheric infarct.

We investigated the differences on brain magnetic resonance imaging (MRI) between small subcortical "lacunar-like" infarcts resulting from large-vessel disease and pure lacunar infarcts These non-stroke findings can be seen at any age, but are more common in older patients who have high blood pressure, diabetes, or other risk factors for vascular diseases like heart attack or stroke. . More studies on mechanisms, prevention, and treatment are needed to provide specific guidance on the long-term management of patients with lacunar infarcts.   The main independent predictors of disability were age, diabetes, history of stroke or transient ischemic attack, and type of lacunar syndrome.  These infarcts are termed "lacunar infarcts" and by definition are less than 1.5 cm in diameter. It suggests that the pathogenesis of lacunar-sized infarction is variable. The prognosis for recovery from the deficit produced by a lacunar infarct is usually good, with partial or complete resolution occurring over the following 4–6 weeks in many instances.

Causes of Lacunar Infarction

Here are the list of the possible Causesof Lacunar Infarction:

• The two groups did not differ in the prevalence of prestroke hypertension (defined in a number of ways) or in the prevalence of markers of sustained hypertension.
• The aetiopathogenesis of small, deep (lacunar) infarcts remains controversial. The view that they are caused by occlusive intrinsic small vessel disease is widely held, but is based on only a small number of detailed pathology studies.
• Our findings suggest that non-valvular atrial fibrillation in lacunar infarcts, as in primary intracerebral haemorrhage, is unlikely to be the cause of this type of stroke, whereas perhaps 30% of all cortical infarcts are not caused by non-valvular atrial fibrillation when present.

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