Clinical Syndromes Lacunar Stroke Laci

Occlusion of deep penetrating arteries produces subcortical infarction characterised by preservation of cortical function - language, other cognitive and visual functions.

Clinical syndromes are distinctive and normally result from long-standing hypertension. In 80%, infarcts occur in periventricular white matter and basal ganglia, the rest in cerebellum and brain stem. Areas of infarction are 0.5-1.5 cms in diameter and occluded vessels demonstrate lipohyalinosis, microaneurysm and microatheromatous changes. Lacunar or subcortical infarction accounts for 17% of all thromboembolic strokes and knowledge of commoner syndromes is essential.

1. Pure motor hemiplegia




Lesion in posterior limb of internal capsule

Clinical: Equal weakness of contralateral face, arm and leg with dysarthria Vessel(s): Lenticulostriate A.

2. Pure sensory stroke

Lesion in VPL nucleus of thalamus

Lesion in VPL nucleus of thalamus

Clinical: Numbness and tingling of contralateral face and limbs. Sensory examination may be normal

Vessel(s): Thalamogeniculate A.

3. Dysarthria/clumsy hand

Lesion in dorsal pons x ^

Clinical: Dysarthria due to weakness of ipsilateral face and tongue associated with clumsy but strong contralateral arm. Vessel(s): Perforating branch of Basilar A.

4. Ataxic hemiparesis

Lesion in ventral pons ^ (interruption of pontocerebellar fibres)

Clinical: Mild hemiparesis with more marked ipsilateral limb ataxia Vessel(s): Perforating branch of Basilar A. (This syndrome can also be produced by anterior capsular lesions)

5. Severe dysarthria with facial weakness

Lesion in anterior limb of internal capsule

Clinical: Dysarthria, dysphagia and even mutism occur with mild facial and no limb weakness or clumsiness.

Vessel(s): Lenticulostriate A.

Sensorimotor syndromes are common although anatomical basis is obscure. A recent Stroke Data Bank survey showed the commonest presentations to be: -

Pure motor hemiplegia 57% Sensorimotor 20% Ataxic hemiparesis 10% Pure sensory 7% Dysarthria/Clumsy hand 6% Investigations MRI is superior to CT in demonstrating lacunae, although either may occasionally misdiagnose a small resolving haematoma. Confirmation of lacunar stroke may save patients from unnecessary investigations for carotid and cardiac embolic source.

Prognosis For all syndromes this is encouraging. Careful control of blood pressure and the use of aspirin usually prevents recurrence. Multiple lacunar infarctions - '├ętat lacunaire' - results in shuffling gait, pseudobulbar palsy and subcortical dementia.

Was this article helpful?

0 0
Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.

Get My Free Ebook

Post a comment