Monday, May 22, 2017

Lacunar strokes : An Overview

      Hi everyone ! Here's a short post on Lacunar infarcts. Credits to IkaN without whom IKant have done this post. Haha ;;) here goes.

- A Lacunar infarct is an infarction occurring    in the deep penetrating branches supplying the deep subcortical structures - Mainly the Internal capsule and parts of thalamus. 

- These are some of the most common infarctions seen. 

- Causes of lacunar infarction include Hypertensive bleeds and Microthrombi. 

- So these infarcts can present as one of the following​ Syndromes --> 

1. Pure Motor 
2. Pure Sensory 
3. Combined Sensorimotor 
4. Ataxic 
5. Dysarthria- Clumsy hand syndrome. 

- The illustrations I've drawn below clearly depict the syndromes , their anatomical localization and the arteries commonly involved. 

- The commonest of the lot is the Pure Motor type of stroke that affects mainly the Internal capsule containing the motor corticospinal fibres. Since a multitude of Fibres is concentrated very judciously in the Internal capsule , the hemiplegia resulting from this type is a 'Dense' or total hemiplegia affecting both upper and lower limbs in equal measure. 
(click on the image to see them in better resolution ) 

- The management is much like the other strokes - 
1. Airway Breathing Circulation to be established. 
2. Check Blood sugar and BP.
3. Send for an emergency Non contrast CT scan to rule out hemorrhage. 
4. If within 3-4.5 hours and absence of hemorrhage = Thrombolyse. 
5. If hemorrhage - BP control and ICT management.
6. If beyond 4.5 hours = Symptomatic and Palliative care and treat risk factors.

- I hope all of these Syndromes are clear to you now !
 Let me know if you'll have any doubts. 
Happy Studying ! 
Stay awesome.
~ A.P.Burkholderia

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