| Lacunar stroke occurs when one of the small | | | | definitions of lacunes have been used. Lacunes |
| arteries (diameter: 0.2 ? 15mm) that provides | | | | may be confused with other empty spaces, such |
| blood to the brain's deep structures is blocked and | | | | as enlarged perivascular (Virchow-Robbins) spaces, |
| injures deeper structures underneath the cortex. | | | | in which the specific small vessel pathology |
| It may be referred to as a Lacunar Infarct | | | | occasionally is absent. Originally, lacunes were |
| (LACI). A patient who presents with the clinical | | | | defined pathologically, but lacunes now are |
| symptoms of a lacunar stroke, but who has not | | | | diagnosed on clinical and radiological grounds. This |
| yet had diagnostic imaging performed may be | | | | problem is compounded by the present inability to |
| described as suffering from Lacunar Stroke | | | | image a single penetrating artery. |
| Syndrome (LACS). | | | | A true lacunar stroke is just like any other stroke |
| A lacunar stroke is a blockage of blood flow to a | | | | in that you would expect sudden onset of |
| part of the brain supplied by one or more small | | | | neurologic problems. Such problems typically |
| arteries. In a lacunar stroke, a blood clot | | | | include weakness or numbness on one side of the |
| (thrombus) blocks blood flow. Lacunar strokes , a | | | | body, trouble producing language (either slurred |
| subtype of ischemic stroke, have earned their | | | | speech or trouble producing what you want to |
| name because the area rendered ischemic takes | | | | say) or trouble with understanding language, and |
| the form of a small lacune or cavity (usually less | | | | visual loss or double vision. Because lacunar |
| than 15mm in diameter). | | | | strokes are smaller, patients with this type of |
| Unlike most arteries that gradually taper to a | | | | stroke are more likely to recover to some extent |
| smaller size, the arteries of a lacunar stroke | | | | when compared to patients who have large |
| branch directly off of a large, high pressure, | | | | strokes, although the extent of recovery is not |
| heavily muscled main artery. A much larger infarct | | | | predictable. Age and severity of stroke are the |
| may actually produce a less extensive (or | | | | biggest predictors of recovery--younger ages and |
| intrusive) neurologic deficit for the patient Lacunar | | | | smaller strokes do better. |
| strokes account for about 20 percent of all | | | | Lacunar strokes tend to occur in patients with |
| strokes in the United States. | | | | diabetes, hyperlipidemia, smoking or chronic |
| A lacunar stroke is a blockage of blood flow to a | | | | hypertension and may be clinically silent or present |
| part of the brain supplied by one or more small | | | | as pure motor hemiparesis, pure sensory loss, or |
| arteries. These arteries are 0.1 to 0.3 millimeters in | | | | a variety of well-defined syndromes (e.g., |
| diameter. They branch from larger arteries near | | | | dysarthria-clumsy hand, ataxic-hemiparesis). |
| the underside of the brain, and carry blood to the | | | | Descending compact white matter tracts or |
| brain's deeper regions, such as the thalamus, basal | | | | brainstem gray matter nuclei are injured, often |
| ganglia and pons. In a lacunar stroke, a blood clot | | | | producing widespread and striking initial deficits. |
| (thrombus) blocks blood flow. | | | | However, the prognosis for recovery with lacunar |
| The lacunar hypothesis proposes that (1) | | | | stroke is better than with large artery territory |
| symptomatic lacunes present with distinctive | | | | stroke, and for this reason many centers favor |
| lacunar syndromes and (2) a lacune is due to | | | | using antiplatelet therapy (aspirin, clopidogrel) or |
| occlusion of a single deep penetrating artery | | | | conservative management rather than |
| generated by a specific vascular pathology. This | | | | thrombolytic therapy for uncomplicated lacunar |
| concept is controversial because different | | | | stroke. |