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Thursday, July 31, 2014
Stroke - lacunar infarction -the relationship
My dad, age 76, had for the past 6 months following symptoms once in a while: 1. Vertigo
2. Inability to walk or stand on his own
3. "Pressure", "Heaviness" on the head /shoulder
4. Sudden dizziness
He is long term hypertensive. No heart disease in family. After months of useless treatment, an MRI revealed "Lacunar Infarction". Doctor prescribed blood thinners and Aspirin and told him to live with it (He lives in India where doctors don`t actually have to explain everything to the patients!!) My research led to confusion. While Stroke and Lacunar infarction were mentioned in the same breath, I could never understand the relationship between the two. So my questions are: 1. Did my dad have a stroke?
2. Will Lacunar infarction lead to stroke?
3. What is the exact relationship between the two?
4. Will he ever regain his mobility?
5. What should be his treatment?
6. What is his prognosis?
From the information you have provided, I cannot answer all of your questions. Many of them cannot be answered without seeing the patient in person and performing a complete medical history and physical exam.
Here are some general thoughts that might be helpful. Lacunar stroke refers to a small stroke in the subcortical regions of the brain (literally, below the cortex/surface of the brain--refers to a small lesion in the white matter and deep structures of the brain).
A true lacunar stroke is just like any other stroke in that you would expect sudden onset of neurologic problems. Such problems typically include weakness or numbness on one side of the body, trouble producing language (either slurred speech or trouble producing what you want to say) or trouble with understanding language, and visual loss or double vision. Because lacunar strokes are smaller, patients with this type of stroke are more likely to recover to some extent when compared to patients who have large strokes, although the extent of recovery is not predictable. Age and severity of stroke are the biggest predictors of recovery--younger ages and smaller strokes do better.
Your father's symptoms are nonspecific, and I am not convinced that he has had a stroke, unless the inability to walk is due to one-sided weakness. Vertigo can be seen if there is a stroke in part of the brain called the brainstem, but can also be seen in ear problems. If he had a brainstem stroke, he would typically have some obvious symptoms such as weakness, numbness, and possibly double vision too.
Stroke is defined by clinical symptoms as described above, not by MRI findings. If your dad didn't have a clinical stroke, it is possible that he has an "abnormal" MRI with periventricular white matter lesions. These look very similar to lacunar strokes, and some people would refer to these findings on MRI (if there is no clinical stroke history) as "silent strokes". This is debatable in my opinion.
I have written extensively about periventricular white matter changes in previously answered questions--please refer to several questions since 10/05 in this same topic area of "Stroke".
As to best treatment for your dad, I cannot answer. This must be worked out with his physician(s).
Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati