What is Lacunar Infarct: Causes, Symptoms, Treatment, Prognosis

Lacunar Infarct is a form of an ischemic stroke occuring within the deepest structures of the brain. Lacunar Infarct occurs when there is a blockage of an artery situated deep within the brain resulting in interrupted blood flow to this region. Studies suggest that of all the cases of infarcts occuring in the United States about 30% of them are Lacunar Infarcts.

Lacunar Infarct just like any other kind of infarct is a serious condition and needs to be taken care of emergently since the brain cells do not get sufficient oxygen due to blockage of the artery causing interrupted blood flow to the region and the brain cells may start to die within minutes if emergent treatment is not given.

As stated above, the main cause of a Lacunar Infarct is lack of blood flow to the deep structures of the brain mainly because of blocked arteries in that region. Chronic and uncontrolled hypertension is one of the main risk factor for Lacunar Infarct, as hypertension causes the arteries to get narrow which makes it easier for cholesterol and other fatty products to block the arteries and block the blood flow to the deep structures of the brain.

Persistent and uncontrolled hypertension is the main risk factor for Lacunar Infarct. The chances of an individual having a Lacunar Infarct also increase with age. Individuals with known cardiac disorders and diabetes mellitus are also at high risk for developing Lacunar Infarct. Lacunar Infarct is also seen more in individuals who are African-Americans and Hispanics. If an individual has a family history of Lacunar Infarct then the chances of that individual getting it also increases.

Some of the other risk factors for Lacunar Infarct are:

• Chronic smoking
• Alcohol abuse
• Recreational drug abuse
• Pregnancy in some cases can cause Lacunar Infarct
• Use of birth control pills can also increase the risk of Lacunar Infarct
• Sedentary lifestyle and not doing any activities also increases the risk of Lacunar Infarct
• Poor diet is yet another risk factor for Lacunar Infarct
• Hypercholesterolemia is another risk factor for Lacunar Infarct
• Medical conditions like obstructive sleep apnea is also a risk factor for Lacunar Infarct

Thus if an individual reaches the age of 50 years old then it becomes vital for him or her to get regular health checks to rule out risk factors for disease conditions like Lacunar Infarct.

The symptoms of Lacunar Infarct start all of a sudden with no precursor. Some of the symptoms of Lacunar Infarct are:

• Slurring of speech
• Inability to raise the arm up overhead
• Facial drooping on one side
• Numbness on one side of the body
• Problems ambulating
• Confusion and altered awareness
• Memory difficulties
• Problems with speaking fluently
• Persistent headaches
• Loss of consciousness
• In some cases coma

Since Lacunar Infarct is an emergent situation and needs immediate treatment hence a confirmed diagnosis of such is absolutely necessary at the earliest possible time. As soon as the patient presents to the hospital with the above mentioned symptoms, the first thing that the doctor does is to check the blood pressure of the patient and inquire about the symptoms that the patient is experiencing.

The next thing to be done is a detailed neurological examination to check whether all the nerve functions are working fine. If a Lacunar Infarct is suspected then the patient will be sent for a stat MRI or CT scan of the brain which will clearly show areas of infarction in the brain. A Doppler ultrasound may also be done to confirm the diagnosis of an infarct. The results of these studies will confirm the diagnosis of a Lacunar Infarct.

The treatment of Lacunar Infarct should start as early as possible so that the chances of the individual surviving that stroke increases. The treatment for Lacunar Infarct starts immediately after the diagnosis is made. Early treatment also prevents any further damage to the brain. The first line of treatment is to give aspirin to minimize risk of having another infarct. The patient will be given supportive measures for assisting in respiratory and heart functioning. The patient may be given clot dissolving drugs either orally or intravenously. Under extreme circumstances, medications are directly administered to the brain for treatment of Lacunar Infarct.

As there is some amount of damage bound to happen due to Lacunar Infarct, the recovery of the patient depends on the amount of damage that has been done to the brain. In some cases, the damage is such that the patient finds it difficult to care for self and needs assistance from other people for performing tasks. In some cases, posttreatment the patient will be sent to a rehabilitation home where the patient needs to learn the lost skills again. This is done by a team of experts in speech, language and motor skills. This may take a lot of time and requires a lot of effort, cooperation, and patience from the patient and his or her family, as it is a long and consorted effort and takes a long time spanning from months to years before the patient can make some sort of improvement after a Lacunar Infarct. 

In some cases, patients who have had a Lacunar Infarct also require 

• Physical therapy for restoration of function
• Occupational therapy to improve skills required for performing activities of daily living
• Speech therapy for improving language skills

The quality of life post a Lacunar Infarct depends on the amount of damage the brain has suffered, the age of the patient, how quickly treatment was started for Lacunar Infarct. In some cases, the patients may never be able to regain their lost skills and may become permanently disabled and end up being paralyzed for the rest of their life, have permanent numbness on one side of the body, and virtually no motor control on one side of the body. 

Even after appropriate treatment following a Lacunar Infarct, some people still remain with memory problems. Some people may have problems with reasoning and thinking. Due to the disability that is caused by Lacunar Infarct, some patients go into depression which may be hard to control post a Lacunar Infarct.