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Tuesday, April 28, 2015
Lacunar infarcts in bilateral external capsul
My dad has been detected with lacunar infarcts in bilateral external capsule and left lentiform nucleus. Mild generalised atrophy.Please kindly let me know if it can be treated using medicines and what are the long term consequences of the above contion. I would appriciate if you reply in details as i have browesed through your webiste and a similar question was answered as refer to perveiously asked questions but unfortunately didnt get a proper review.
Many thanks for your help
I cannot answer in detail for most of the questions recently submitted, given the information provided. Your question presumably revolves around an imaging report? If yes, I cannot definitively answer your questions.
The imaging findings may or may not be clinically significant. The first thing to determine is whether or not your father has actually had a clinical stroke--has he had the sudden onset of weakness or numbness of one side of his body or face, with or without vision loss, slurred speech, language difficulty (understanding or producing meaningful speech), etc. ? If yes, it is important that he work with his local physicians to modify his risk for future events. This would involve appropriate use of stroke preventative medications: antiplatelet agents like aspirin (although there are several choices, and the most appropriate choice could only be determined after taking a full history and doing an exam), blood pressure medications, and cholesterol lowering agents (same proviso).
If your father has NOT had a clinical change as described above, then the imaging findings are not a diagnosis but simply a description of what the radiologist saw on his CT or MRI. I have written extensively about these types of changes, which would fall under the heading of "white matter changes", and would respectfully suggest that you search the stroke section for previous answers or read the attached document about the potential significance. To be clear, these sort of findings (when not linked to a clinical event) are relevant only that they indicate the potential increased risk for heart attack or stroke, and potentially increase the risk for future cognitive decline/dementia. The increase in risk applies to the population of all persons with these findings, but it is not possible to predict the individual risk for one person--in other words, while he might have "small vessel ischemia/white matter changes" he might not ever go on to have a stroke, heart attack, or dementia. In either case, given the potentially increased risk, we would want to start the same kind of preventative medications as described above, but cannot give more information about the actual significance of these findings for him.
I hope this has made sense and been helpful. Please do make sure that your father continues to work with his local physicians for his long term benefit.
Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati