Concept and treatment of lacunar infarction?

After the clinical manifestations of a stroke, many patients’ CT examination results show lacunar infarction. What is lacunar infarction?

Lacunar infarction usually occurs on the basis of arteriosclerosis and hypertension. In the deep tissues of the brain (mainly in the basal ganglia, internal capsule, thalamus, brainstem, etc.), there are tiny emboli with a diameter of about 2 millimeters. After the formation of microemboli, the body’s macrophages are activated to engulf the infarcted tissue, leaving some cavities. This is known as lacunar infarction. Due to the small size of the lacunar infarction lesions and their ability to be absorbed by the body’s own phagocytic function, the clinical symptoms are mild and recovery is relatively fast.

Lobar cerebral infarction, due to the small size of the infarction focus and the absorption of the infarcted tissue, has a short clinical manifestation, mostly presenting with a slow onset. About 20% of patients have a history of minor stroke attacks. A few patients experience symptoms such as headache, dizziness, and hiccups after the onset of the disease.

The clinical manifestations of stroke in this disease can be divided into pure motor stroke, pure sensory stroke, sensorimotor stroke, and basilar artery branch syndrome.

  1. Pure motor stroke: manifesting only as facial paralysis and hemiplegia, with uniform severity of paralysis in both upper and lower limbs. The sensory function on the affected side is normal, without numbness or other abnormalities, and the consciousness, language, and vision are also normal. Some patients experience balance disorders, ataxia, and language disorders (dysarthria) simultaneously with facial paralysis and hemiplegia.
  2. Pure sensory stroke: patients have normal limb movement but abnormal sensory symptoms, such as numbness, pain, and temperature loss. The sensation on both sides is significantly separated along the midline, with one side completely normal and the other side abnormal.
  3. Sensorimotor stroke: initially presenting with numbness in one limb, followed by mild hemiplegia.
  4. Basilar artery branch syndrome: manifesting with a series of mild neurological symptoms, such as slight paralysis in one foot; or no limb symptoms but dysarthria; no facial paralysis or only mild hemiplegia; ocular paralysis with inability to voluntarily move the eyes and mild hemiplegia; dysarthria accompanied by instability while walking and ocular muscle paralysis.

The general treatment for lobar cerebral infarction is the same as for cerebral arteriosclerosis. Hypotensive treatment can be applied only after the stroke symptoms stabilize. Vasodilators and volume expanders such as low-molecular-weight dextran can be selected for use. Anticoagulant treatment, such as warfarin, should be used cautiously due to its potential risks.

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top