For many people, the word "stroke" or "cerebral infarction" is associated with vivid symptoms and severe, often irreversible, consequences. However, there are disorders of the blood flow in the brain that are not manifested by paralysis or speech disorders, such symptoms characteristic of a stroke. These circulatory disorders include lacunar infarction. But it should be noted that even an asymptomatic stroke can be insidious and lead to serious consequences.
Lacunar infarction of the brain: what is it?
This is a type of stroke, that is, an acute circulatory disturbance in the brain, which is characterized by the presence of foci of dying brain tissue (necrosis) of small sizes, located deep in the tissues of the cerebral hemispheres or brain stem. This size of necrosis is determined by the small diameter of the vessels clogged by a thrombus or embolus (with ischemic stroke) or damaged by a rupture of the thinned wall (with hemorrhagic stroke). Most often it is lacunar ischemic infarction that arises , and not hemorrhagic.
Since the diameter of the damaged vessels is insignificant, changes in the brain are often detected by chance, when examined for other diseases. If the site of necrosis has a small diameter, then even modern magnetic resonance imaging is unable to visualize it. And necrosis larger than 20 mm is extremely rare and is called giant.
Classification
This disturbance of cerebral circulation is divided depending on the catastrophe in the vessels of which blood supply to the brain. In total, there are two vascular pools: carotid and vertebrobasilar. Thus, there are two types of cerebral infarction:
- lacunar infarction in the area of basal structures - occurs when there is a violation of blood flow in the vertebrobasilar pool;
- heart attack in the cerebral hemispheres - appears when carotid circulation is disturbed.
Main reasons
The reasons for the development of strokes, including lacunar, are very individual. The pathology that caused lacunar cerebral infarction in one person may never cause such problems in another. However, you need to know that the following risk factors for stroke require a doctor's consultation in order to correct them and prevent the development of serious consequences. The main causes of lacunar infarction include:
- high blood pressure (hypertension);
- excessive body weight;
- atherosclerosis - an increase in cholesterol with the deposition of fatty plaques on the vessel wall;
- vasculitis - inflammation of the vascular wall;
- diabetes;
- violation of the heart rhythm (arrhythmia);
- coronary heart disease.
General clinical manifestations
As noted above, lacunar infarction is often asymptomatic, without causing any discomfort to the victim. But in the presence of larger foci of necrosis, an erased symptomatology may develop, which is prone to a gradual increase with an increase in the size of damaged brain tissue.
For all types of lacunar stroke, the following features are characteristic:
- history of hypertension;
- frequent onset at night;
- gradual increase in focal symptoms;
- rapid recovery within 6 months, during which the development of repeated lacunar infarction is also possible.
Clinical manifestations depending on localization
In addition to the size of the damage, the symptoms also depend on whether the circulatory disturbance of the brain occurred in the blood circulation: carotid or vertebrobasilar.
So, if there is a blockage of the vessel in the carotid pool, a slow, for several hours or even days, increase in focal symptoms will be characteristic: slight weakness in the muscles of the extremities, the face, which is replaced by a stronger one (paresis), impaired skin sensitivity. Such changes usually occur in isolation, that is, only on one arm or leg, or only on the face. They are also prone to quick recovery, after about six months, sensitivity and motor functions completely return to normal.
If there are changes in the vertebrobasilar pool, the patient experiences dizziness, headache, nausea, and rarely - vomiting. The development of paresis and impaired sensitivity is not characteristic.
Diagnostics
It is quite difficult to determine the focus of lacunar infarction in the brain, given its small size and the frequent absence or insignificance of symptoms, which make the patient consult a doctor. Therefore, such a focus is visualized only with its dimensions of more than 15 mm. Often this happens spontaneously when examined for other diseases.
The main methods for visualizing the brain in any stroke, including lacunar:
- CT scan.
- Magnetic resonance imaging is the most modern and effective method for visualizing a small focus of a stroke in the brain.
Consequences of the disease
Since a lacunar stroke is characterized by its, in most cases, asymptomatic course, its diagnosis, and therefore timely treatment, is often difficult, which leads to the development of complications. Among the main consequences of lacunar infarction of the brain, both those that occur in the short term after a heart attack (the first six months) and the more distant consequences are distinguished.
In the first six months, the progression of vascular disorders may occur with the development of a more severe stroke, repeated lacunar strokes.
Among the more distant consequences that develop several years after the episode of a lacunar stroke, the most common are vascular dementia, that is, dementia, and mental health problems. This is manifested by sharp mood swings, changes in behavior up to the complete impossibility of self-service.
The main outcome of a lacunar infarction, which is not dangerous, is the formation of a brain cyst. This is a circular cavity filled with liquid. It is her visualization on MRI that confirms the lacunar stroke suffered in the past.
Treatment principles
Treatment of lacunar infarction is carried out in the department of neurological diseases. Not only treatment of direct disturbances in cerebral circulation, but also treatment of risk factors that led to its development, restoration of nerve tissue, prevention of relapses of lacunar stroke and prevention of the development of long-term consequences and complications should be carried out.
Therapy of circulatory disorders
The treatment of lacunar stroke directly depends on its type. For ischemia, that is, a clot with a blood clot, antiplatelet agents (prevent platelet adhesion and the formation of a blood clot) and anticoagulants (prevent the formation of coagulation factors - proteins that thicken the blood) are used. The main antiplatelet agent is acetylsalicylic acid, the anticoagulant is heparin, warfarin.
In hemorrhagic stroke, therapy is aimed at stopping bleeding into the brain parenchyma from a ruptured vessel. For this, an inhibitor of fibrinolysis - alpha-aminocaproic acid is used.
Sometimes, upon detection of significant stenosis of the artery (more than 80%) and a large focus of necrosis, neurosurgical intervention is indicated. But surgery is a rarity in patients with lacunar infarction.
Risk Management
Since in almost 100% of cases, the development of lacunar stroke is accompanied by an increase in blood pressure, it is necessary to carry out drug therapy to reduce it. However, it should be remembered that the decrease in pressure should be gradual and not very significant. In a hospital, magnesia is most often used for these purposes; it is also possible to use ACE inhibitors (Captopril, Enalapril), diuretics (Furosemide), calcium channel blockers (Nifedipine, Verapamil).
For the prevention of repeated ischemic strokes in the presence of high blood cholesterol in a patient, drugs are used to reduce it. The most effective is the group of statins ("Atorvastatin", "Lovastatin"). It is worth noting that in order to achieve the effect, it is also necessary to adhere to a diet, and drugs should be taken systematically.
If the patient has diseases of the cardiovascular system, it is necessary to consult a cardiologist who will select the necessary medicines. For example, with arrhythmias, in addition to the use of antiarrhythmic drugs, it is also necessary to take anticoagulants for the prevention of repeated thrombosis and embolism.
Preparations for the restoration of nerve tissue
In order to shorten the recovery period after a lacunar stroke and to ensure complete recovery of the nervous system, drugs such as:
- nootropics - improve blood circulation in the brain, increase oxygen delivery to nerve cells and accelerate metabolism ("Cerebrolysin");
- multivitamin complexes - especially B vitamins, which have a beneficial effect on the nerves, in particular on their membrane;
- means for strengthening the vascular wall - Trental.
Forecast
The prognosis for the development of lacunar stroke with timely diagnosis is favorable, characterized by rapid and complete recovery. However, relapses of the stroke, the presence of many lesions reduce the chances of a full recovery.
There is evidence that 10 years after a lacunar stroke, only 30% of patients remain alive, many of which show signs of vascular dementia.
Many are also interested in the question: is it possible to work with lacunar infarction of the brain? During treatment and the rehabilitation period, it is worth abandoning increased mental and physical stress, as this can lead to a recurrence of a heart attack or further development of adverse consequences (dementia, mental disorders).
It can be concluded that such, at first glance, an insignificant pathology, such as a lacunar stroke, can lead to irreversible consequences in the absence of timely diagnosis and treatment. Therefore, this pathology should be given special attention by neurologists and radiologists, and a person who has felt the symptoms listed above should not delay, but immediately seek qualified help. After all, our health is in our hands!