Routinely   a person is diagnosed to be having a stroke when there is sudden and dramatic onset of paralysis of one or more parts of the body with or without loss of consciousness. This usually occurs due to sudden cessation of blood supply to part of the brain, rendering affected tissue necrotic and non functional. The underlying cause is commonly a blood clot blocking the lumen of one or more of the blood vessels supplying the brain. It can also be due to minor or major bleeding in the blood vessels.  The net result of either   of these mechanisms is death of part of brain tissue.

Lacunar infarcts    occur commonly   due to   a blood vessel being blocked by a clot from a plaque of atheroma (fat deposit in inner lining of blood vessel), leading to reduced blood supply and death of part of brain tissue. These infarcts are very small in size, (0.5-1.5 mm).   They occur   due to occlusion of small branches of major blood vessels. The small branches supplying deeper part of brain tissue are the ones to be affected. The physical manifestations   may    not be   as dramatic as   that due to obstruction of larger blood vessels. Therefore   at times they pass unnoticed as strokes.

These types of infarcts   constitute about 25% of all stroke cases. The damage mostly occurs in and around mid brain or lower part of brain.

Advanced age, chronic hypertension, increased lipid levels in blood, diabetes, smoking and alcohol consumption are the risk factors which increase the possibility of an individual developing lacunar infarcts.

The physical manifestations may be sudden or gradual in onset. Sometimes there may be paralysis of one side of the body. One may have gradual onset of weakness of legs and or   loss of equilibrium while walking. Some individuals develop gradual difficulty in speaking or eating with no visible paralysis of any part. A person may have weakness of one hand,   which comes   after writing or working with the hand. At times there may be abnormal sensations like tingling, numbness in one hand or one half of body. Instead of any outward manifestation, one may only develop mood changes like depression, apathy towards surroundings and or loss of orientation and cognition. People having such cognitive symptoms   are mistaken to be having senile dementia, i.e. dementia occurring due to old age.

Such bizarre symptoms which   start suddenly or slowly can mimic many infectious diseases or malignancies affecting the brain. A high degree of suspicion is needed to diagnose lacunar infarct. Diagnosis is confirmed by means of imaging techniques like C.T. scan and M.R.I.  if a patient with lacunar infarct is diagnosed within 2 hours of onset of lacunar infarct, thrombolytic therapy (resolving the obstructing clot by means of medicines like streptokinase), can help in preventing the spread of the infarct. Drugs which help in reperfusion of the surrounding brain tissue are also helpful. Supplements of vitamin B. complex   taken help in   providing relief from troublesome abnormal sensations like tingling and numbness.

Apart from this, if a person   is unable to move or feed himself or care for himself, he needs special attention.   Particular attention should be given to his feeding and cleanliness. If bedridden, family should keep him dry and turn him frequently to prevent bed sores.

A healthy life style from an early age can very well prevent any type of stroke including lacunar infarcts. Fat free diet, consumption of plenty of fresh fruits and vegetables with milk and milk products and fish helps in preventing atherosclerosis (deposition of fat in inner layer of blood vessels) and lacunar infarcts later in life. Regular physical exercise is very beneficial in controlling hypertension and diabetes, in preventing obesity and also atherosclerosis. Thus the risk for lacunar infarcts is minimized.

People having diabetes and or hypertension should be compliant with the diet schedules and medicines.

If an elder in the family starts behaving abnormally or looks lost, he or she should be evaluated for lacunar infarcts before being considered as having depression or senile dementia.

Dr. Rachna Pande
E-mail-rachna212002@yahoo.co.uk