What is a lacunar cerebral infarction? This is nothing but an ischemic stroke of the brain with its own physiological and anatomical features, which is why it is called lacunar.
This form of cerebrovascular disease was highlighted by the discovery and implementation of techniques that allow specialists to see changes in the brain - computerized, magnetic resonance imaging( MRI).
Characteristics of such a stroke
These are acute circulatory disturbances in the brain developing in the deep arteries of the brainthe brain. The foci have a small diameter, about 1-1.5 cm .Over time, in place of a small area of ischemia, a lacunae cyst is formed, so this kind of stroke was called a lacunar infarction.
According to special medical literature, lacunar infarctions of account for 15% of all strokes of .By studying the issue at different times, Russian neurologists: E.I.Gusev, E.V.Schmidt, V.I.Skvortsova. Thanks to their efforts, it has been established that the problem frequency among able-bodied people( 25-64 years) is 1-3 cases per 1000 population.
Causes and risk factors for
The main causes of the appearance of lacunae are:
- Arterial hypertension. The development of lacunar infarction is possible both in the course of its crisis and at stable arterial pressure.
- Brain atherosclerosis .Despite the presence of atherosclerotic lesions of the main arteries of the head, there are no significant stenoses in most cases.
- The combination of atherosclerosis and hypertension.
- Congenital features of or malformations of cerebral vasculature.
- A lacunar stroke can be caused by the microembela of the small arteries .This happens with some rhythm disturbances( atrial fibrillation), after a heart attack.
- Diabetes mellitus .Increased blood glucose causes specific diabetic lesions - angiopathy of vessels, including the brain. Progression of atherosclerosis is directly proportional to the severity of diabetes.
- Smoking .Nicotine increases the viscosity of the blood and causes spasm( constriction) of the vessels.
Clinic: Symptoms and signs
Usually the disease proceeds without loss of consciousness. Because of the poverty of symptoms, it is often diagnosed with a delay. At the time of the development of a heart attack, there may be an increase in blood pressure or a rhythm disturbance. Single gaps are manifested by neurologic symptoms, which do not lead to complete immobility and the need for extraneous care.
Clinical Symptom Options:
- Motor lacunar infarction .It is manifested by an easy restriction of the mobility of either one limb or both.
- Sensitive infarction of .This is a decrease in the sensitivity of half the body or limb.
- Coordinator insult .There are violations of coordination. The patient complains of dizziness, insecure gait due to unsteadiness.
- Lacunar infarction, manifested by intellectual disorders : slowing down of thought processes, memory loss, attention.
Other variants of are possible with a combination of the described clinical signs or, conversely, with no symptoms.
The Danger and Consequences of
The years of observation have shown that in one third of patients after similar disorders of cerebral circulation, parkinsonism develops in a year, and in the long run there is dementia or, in a different way, vascular dementia .
Another phenomenon often results in depression, withdrawal to .Usually this happens when multiple lacunae appear.
Classification of
The clinical classification is based on clinical symptoms and is reviewed in the section on the symptoms of lacunar infarction.
In the development of the disease, the following are distinguished:
- The most acute period is the first 3 days;
- acute - 28 days;
- early recovery - the next 6 months after a circulatory disturbance;
- late recovery - for 2 years.
Because of mild symptoms and lack of pronounced motor speech and sensitive disorders , it is very difficult to describe the characteristics of each gap. Therefore, this division is of secondary importance.
Diagnosis
It is possible to suspect a lacunar infarction on the basis of a patient's complaints. However, with full confidence to talk about the nature of brain damage is possible after a detailed examination using high-tech equipment.
Usually this tomography , which examines the brain at various levels. The device makes step-by-step, virtual slices.
A signal from the structures of the human body is fed to the personal computer of a radiologist and converted into an image. The smaller the step, the higher the likelihood of detecting a lacuna.
Simultaneously it is necessary to conduct search for the causes of infarction. Diagnostic complex is as follows:
- General clinical tests of blood and urine .Blood test for glucose. Biochemical analysis, with determination of the level of cholesterol and lipoproteins, indicators of the blood coagulation system.
- Electrocardiography for the diagnosis of rhythm disturbances( the table of decoding and the norms of ECG in adults can be found in another article).
- Ultrasound duplex scanning .Ultrasound allows you to see the wall of the vessel with congenital defects and signs of atherosclerosis.
Tactics of treatment
For adequate therapy and in future with the aim of preventing repeated violations of cerebral circulation, patients are assigned aspirin to reduce the aggregation of blood elements( gluing and forming blood clots) and improve its fluidity. The most acceptable dose is 75 mg of acetylsalicylic acid, manufactured specifically for this purpose.
Normalization of blood circulation is achieved by prescribing drugs that improve microcirculation. Optimal choice - nicergoline, vinpocetine, pentoxifylline .First, a course of intravenous drip introductions, with the transition to a long reception of tableted forms.
neurotrophic is recommended at the same time - medications that optimize oxygen supply to the brain and stimulate recovery. These are cerebrolysin, actovegin, citicoline and ginkgo biloba preparations( memantine, tanakan, bilobyl).
With the development of signs of dementia and the formation of a lacunar state, anticholinesterase drugs and precursors of acetylcholine, a biologically active substance participating in impulses along the nerve trunks, are prescribed. This is neuridine, neurromidine, galantamine in the necessary dosages.
In parkinsonism, , the patient needs specific drugs to reduce tremor( cyclodol, amantadine).
Since the leading cause is hypertensive disease, its adequate reduction can be considered as one of the links in the healing process. Selects an adequate dose and combination of drugs therapist and cardiologist. When appointing a correction scheme, the age of the patient and the presence of significant co-morbidities of are taken into account: diabetes mellitus, chronic kidney diseases.
Prognosis and prevention
The role of aspirin and other blood thinners was mentioned above. However, without the correction of lifestyle, changes in the habitual settings concerning nutrition and bad habits of , it is impossible to successfully combat the consequences of lacunar infarction, prevention of lacunar status and vascular dementia.
What is meant by this:
- Increase in motor activity, decrease in diet, products containing cholesterol.
- Non-smoking and alcohol abuse .A glass of red dry wine is allowed in the absence of other contraindications.
- Compliance with absolutely all recommendations for the treatment of hypertension and diabetes.
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Detection of signs of atherosclerotic lesion during ultrasonic duplex scanning, high level of "bad" cholesterol and lipoproteins - indications for the appointment of a hypocholesterol diet and drugs that reduce cholesterol.
Take these drugs for a long time, under the control of a biochemical blood test because of their hepatotoxicity. If there is a pronounced, more than 70%, stenosis of the main arteries, a consultation of the vascular surgeon is recommended.
- With a high risk of embolism of , adequate treatment of arrhythmia and the appointment of powerful drugs for dilution of blood are indicated. Categorically it is not recommended to engage in self-medication, as these funds, if illiterate, can cause deadly bleeding.
The prognosis depends on the discipline of the patient and his relatives , who should be interested in recovering and preventing the development of intellectual disorders in the patient.
