What is Lacunar Stroke

Lacunar stroke (lacunar infarction) is caused by a blockage in one of the small arteries deep in the brain.

A stroke is the sudden death of brain tissue that occurs when an area of the brain does not get enough oxygen.

Lacunar stroke is a medical emergency that must be treated right away.It is important to get help right away as soon as you notice symptoms of stroke.

What are the causes?

A lacunar stroke occurs when small arteries deep in the brain become more narrow due to a buildup of fatty deposits in the arteries (atherosclerosis). When the arteries narrow, less blood flows to certain areas of the brain. Without enough blood and oxygen, these parts of the brain can die or become permanently damaged.

What increases the risk?

You are more likely to develop this condition if:

• You have high blood pressure (hypertension).
• You have high cholesterol (hyperlipidemia).
• You smoke.
• You have diabetes.
• You are obese.
• You have an unhealthy diet. This includes foods that are high in saturated fat, trans fat, and salt (sodium).
• You have a heart rhythm disorder (atrial fibrillation).
• You have heart disease.
• You have artery disease, such as carotid artery disease or peripheral artery disease.
• You have sickle cell disease.
• You are age 60 or older.
• You have a personal or family history of stroke.
• You are African-American.
• You are a woman who:
  • Is pregnant.
  • Has a history of diabetes during pregnancy (gestational diabetes).
  • Has a history of preeclampsia or eclampsia.
  • Has had hormone therapy after menopause.
  • Uses oral birth control (contraception), especially while smoking.

What are the signs or symptoms?

Symptoms of this condition usually develop suddenly. They may include:

• Weakness or numbness in your face, arm, or leg, especially on one side of your body.
• Trouble walking or difficulty moving your arms or legs.
• Loss of balance or coordination.
• Confusion.
• Slurred speech (dysarthria).
• Trouble speaking, understanding speech, or both (aphasia).
• Vision problems in one or both eyes.
• Dizziness.
• Nausea and vomiting.
• Severe headache with no known cause.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• Blood tests.
• A CT scan of the brain.
• MRI.
• Ultrasound of an artery. This may help find blood flow problems or blockages.
• Angiogram. During this test, dye is injected into your blood and then an X-ray is done to look for blockages. The dye helps blood flow and blockages show up clearly on X-rays.
• Electroencephalogram (EEG). This test checks electrical activity in the brain.

How is this treated?

This condition must be treated within 4.5 hours of the start of the stroke. It is treated with IV medicine that dissolves the blood clot (tissue plasminogen activator, TPA) that is causing the blockage. The goal is to restore blood flow to the brain as soon as possible.

Your health care provider may prescribe blood thinners (antiplatelets or anticoagulants) to lower your risk of another stroke.

Follow these instructions at home:

Medicines

• Take over-the-counter and other prescription medicines only as told by your health care provider. This includes diabetes or cholesterol medicine.
• If you were told to take a medicine to thin your blood, such as aspirin, take it exactly as told by your health care provider.
  • Taking too much blood-thinning medicine can cause bleeding.
  • If you do not take enough blood-thinning medicine, you will not have the protection that you need against another stroke and other problems.

Eating and drinking

• Follow instructions from your health care provider about eating and drinking restrictions.
• Eat a healthy diet. This includes plenty of fruits and vegetables, lean meats, whole grains, and low-fat dairy products.
• Avoid foods high in saturated fat, trans fat, or sodium.
• Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer, 5 oz of wine, or 1½ oz of hard liquor.

Safety

• If you need help walking, use a cane or walker as told by your health care provider.
• Take steps to lower the risk of falls in your home. This may include:
  • Using safety equipment, such as raised toilets and a seat in the shower.
  • Removing clutter and tripping hazards from walkways, such as cords or rugs.
  • Installing grab bars in the bedroom and bathroom.

Activity

• Exercise regularly, as told by your health care provider.
• Take part in rehabilitation programs as told by your health care provider. This may include physical therapy, occupational therapy, or speech therapy.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Get help right away if:

• You have any symptoms of stroke. “BE FAST” is an easy way to remember the main warning signs of stroke:
  • B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
  • E – Eyes. Signs are trouble seeing or a sudden change in vision.
  • F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
  • A – Arms. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
  • S – Speech. Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
  • T – Time. Time to call emergency services. Write down what time symptoms started.
• You have other signs of stroke, such as:
  • A sudden, severe headache with no known cause.
  • Nausea or vomiting.
  • Seizure.
• You have a severe fall or injury.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• A lacunar stroke (lacunar infarction) is a blockage of one of the small arteries deep in the brain. When one of these arteries is blocked, parts of the brain do not get enough oxygen and may die.
• This condition is a medical emergency that must be treated right away. Treatments must be done within 4.5 hours of the start of the stroke.
• Controlling your risk factors for stroke is the best way to avoid another lacunar stroke.
• Get help right away if you have any symptoms of stroke. “BE FAST” is an easy way to remember the main warning signs of stroke.