Lacunar Infarct

Abstract

The term lacuna, or cerebral infarct, refers to a well-defined, subcortical ischemic lesion at the level of a single perforating artery, determined by primary disease of the latter. The radiological image is that of a small, deep infarct. Arteries undergoing these alterations are deep or perforating arteries with a diameter ranging between 100 and 400 microm, numbering 6-12, that generally originate at right angles directly from the main arteries. The concept of lacunar syndrome was introduced in clinical practice to describe those clinical pictures that generally, although not always, have a cerebral infarct of lacunar type as the underlying mechanism. Classic clinical syndromes induced by lacunar infarcts are, in decreasing order of frequency, pure motor stroke, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and dysarthria with motor disability of one hand, as well as a number of rare or incomplete syndromes. Small lacunar infarct that will then degenerate into a lacuna is caused by a reduction of blood flow to a perforating artery. In turn, this is the result of various arterial disorders, the most frequent of which include microatheroma, lipohyalinosis, fibrinoid necrosis, and Charcot-Bouchard aneurysm. Other forms of arteriopathy that can affect small vessels include amyloid angiopathy, and cerebral autosomic dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Hemodynamic disorders also can be a cause of the disease. Diagnosis is made with 1,5 Tesla MRI and prognosis is generally good.

White Matter Hyperintensities in Older Adults and Motoric Cognitive Risk Syndrome

“…Anatomic and physiolopathologic studies suggest that most WMH have a chronically ischemic pathogenesis and are a product of widespread cerebrovascular disease and reduced vascular integrity [15, 16]. Lacunar infarcts, however, are the product of a subcortical ischemic lesion at the level of a deep perforating artery secondary to an occlusion [46, 47]. Perhaps the ubiquitous presence of WMH present in the vast majority of older non-demented adults are a general marker for cerebrovascular disease, and the relatively less common lacunar infarct is a more specific marker for MCR when present in specific regions like the frontal lobe [14].…”

Adults With Late Stage 3 Chronic Kidney Disease Are at High Risk for Prevalent Silent Brain Infarction

“…SBI represents a neuropathological change incorporating wall thickening and hyaline deposition in small end-perforating arterioles in the white matter of the brain. 30 White matter lesion appears in neuronal loss, ischemic demyelination, and gliosis. 31,32 White matter lesion can be present not only in stroke 33 but also in multiple sclerosis and pyridoxine deficiency.…”

Wall-to-Lumen Ratio of Retinal Arterioles and Arteriole-to-Venule Ratio of Retinal Vessels in Patients with Cerebrovascular Damage

“…The term lacunar infarct refers to a well-defined, subcortical ischemic lesion at the level of a single perforating artery with a diameter ranging between 100 and 400 m (sizes similar to the diameter of retinal arterioles) generally originating at right angles directly from the main cerebral arteries. 12 Second, subjects with essential hypertension stage 1 or 2 (defined as daytime systolic BP Ն 135 mm Hg and diastolic BP Ն 85 mm Hg 13 or on antihypertensive treatment with at least one antihypertensive drug according to the European Guidelines of Hypertension 14 ) without a history or a clinical sign of a cerebrovascular event. Exclusion criteria were renal impairment (defined by serum creatinine above 1,2 mg/dL), diabetes mellitus (defined by a fasting glucose Ն 126 mg/dL), any form of secondary arterial hypertension, eye disease other than grade I or II hypertensive retinopathy, atrial fibrillation, atrioventricular block II or higher, dilatative cardiomyopathy, a history of vasculitis, seizure disorder, and treatment with any vasoconstrictive drug.…”