Among the deadly health threats we know about cerebral infarction, there is a detail that is often overlooked, and that is lacunar cerebral infarction. It is like an "invisible assassin" in the brain, although it is small, but its impact is far from underestimated.
What is lacunar cerebral infarction?
Lacunar cerebral infarction refers to cerebral infarction caused by small arteries in deep brain structures, such as the basal ganglia, brainstem, or white matter. These arterioles are usually only 0.2-15 mm in diameter, but their blockage or damage can lead to disruption of blood flow in localized areas of the brain, causing ischemia or necrosis of brain tissue.
Small arterioles, big problems
The incidence of lacunar cerebral infarction is quite high, accounting for 20%~30% of cerebral infarction. Common sites include putamen, caudate nucleus, internal capsule, thalamus and pons. Since most of the arteries in these sites are deep perforating arterioles and have a limited range of blood supply, the occlusion of a single branch will only cause ischemic necrosis of a small area of brain tissue, forming a so-called "lacuna". The size of these cavities is usually between 0.2~15 mm, and they are multiple, and the small infarct foci are only slightly larger than the diameter of the blood vessels.
Why does lacunar cerebral infarction occur?
1. High blood pressure: Long-term hypertension can lead to arteriolar sclerosis and gradual occlusion, which is the most common cause of lacunar cerebral infarction.
2. Diabetes: Diabetes can accelerate the hardening process of blood vessel walls and increase the risk of cerebral small vessel disease.
3. Smoking: Smoking can damage the vascular endothelium and promote atherosclerosis, thereby increasing the risk of lacunar cerebral infarction.
4. High cholesterol: High levels of cholesterol in the blood may lead to the deposition of substances in the lumen of blood vessels, increasing the likelihood of small vessel infarction.
5. Heart disease: Certain types of heart disease, such as atrial fibrillation (atrial fibrillation), can cause blood clots, which can carry through the bloodstream into the small blood vessels of the brain and cause infarction.
6. Blood diseases: such as polycythemia, thalassemia, etc., can lead to increased blood viscosity, affect normal blood circulation, and may cause lacunar cerebral infarction.
7. Lifestyle: Lack of exercise, poor diet, excessive alcohol consumption, etc. may also increase the risk of lacunar cerebral infarction.
8. Age and genetics: As we age, problems that may arise during the natural aging of blood vessels, as well as genetic factors, may also increase the risk of developing lacunar cerebral infarction.
9. When lacunar cerebral infarction occurs, patients may experience symptoms such as hemiplegia, crooked corners of the mouth, slurred speech, paresthesia or unsteady gait. This type of cerebral infarction usually appears as a small round or oval low-density area on CT or MRI of the brain on medical imaging.
Prevention and treatment of lacunar cerebral infarction should focus on controlling its risk factors.
Clinical manifestations of lacunar cerebral infarction
1. Movement disorders: such as hemiplegia or limb weakness, because the affected area controls muscle motor function in the brain.
2. Sensory impairment: numbness or abnormal sensation in a part of the body can occur below the corresponding cortex in the infarcted area.
3. Speech difficulties: If the infarction affects the language center of the brain, the patient may experience symptoms such as difficulty swallowing and slurred speech.
4. Gait abnormalities: lacunar cerebral infarction may cause difficulty walking, manifested by gait instability, especially when the cerebellum or posterior limb of the internal capsule is involved.
5. Cognitive dysfunction: A series of small lacunar infarcts can gradually accumulate damage, leading to cognitive decline, such as memory loss, difficulty concentrating, etc.
6. Mood changes: Mood problems such as depression or irritability may also be associated with lacunar cerebral infarction.
7. Urinary incontinence: Urinary incontinence may occur especially in patients with more white matter lesions and more serious cumulative damage.
8. Dementia: In the case of multiple lacunar infarctions over a long period of time, vascular dementia may develop.
It is important to note that some lacunar infarcts may be completely asymptomatic or very mild and can only be detected by brain imaging tests, such as MRI. This condition is called "silent lacunar infarction" or "silent cerebral infarction".
How is it treated?
1. Acute treatment:
For a newly occurring lacunar cerebral infarction, rapid assessment of suitability for thrombolytic therapy is required.
Hypertension should be controlled, but caution is required to avoid cerebral hypoperfusion due to rapid lowering of blood pressure.
Maintain water and electrolyte balance and normal blood sugar levels.
2. Prevent recurrence:
Antiplatelet therapy: Commonly used drugs include aspirin, clopidogrel, etc., to reduce the risk of recurrence of cerebral infarction.
Anticoagulation: If you have a condition such as atrial fibrillation, you may need to use warfarin or newer oral anticoagulants.
3. Control risk factors:
High blood pressure: It is necessary to maintain blood pressure in a relatively desirable range for a long time.
Diabetes: Strict control of blood sugar.
High cholesterol: control of blood lipids through diet, exercise, and if necessary, lipid-lowering medications.
Quit smoking and limit alcohol.
4. Rehabilitation:
Physiotherapy and occupational therapy: rehabilitation training for patients' functional impairments.
Speech therapy: If there are speech or swallowing problems.
5. Regular follow-up:
Regular follow-up visits to the neurologist to monitor changes and adjust treatment options.
Blood and imaging tests are checked regularly to monitor the progression of the disease and the response to medications.
If you or someone you care about is experiencing similar symptoms, seek medical attention and follow your doctor's instructions. Each patient's specific treatment plan should be tailored to the patient's specific situation.
How to prevent lacunar cerebral infarction
1. Control blood pressure: Maintaining healthy blood pressure levels is key to preventing lacunar cerebral infarction. If you have high blood pressure, follow your doctor's recommendations and prescriptions to manage it.
2. Maintain healthy blood sugar levels: If you have diabetes, control your blood sugar through diet, exercise, and necessary medications.
3. Improves blood lipid levels: Lowers bad cholesterol (LDL) in the blood and raises the level of good cholesterol (HDL). Medication can be used if necessary.
4. Smoking cessation: Smoking can significantly increase the risk of cerebral infarction, and quitting smoking can significantly reduce this risk.
5. Limit alcohol consumption: Excessive alcohol consumption can increase the risk of cerebral infarction, and it is wise to drink alcohol in moderation or abstain from alcohol altogether.
6. Eat a healthy diet: Eat foods rich in vegetables, fruits, whole grains, and omega-3 fatty acids, and limit foods high in salt, sugar, and fat.
7. Exercise regularly: Engaging in regular, moderate-intensity physical activity can help manage weight and improve cardiovascular fitness.
8. Control your weight: Being overweight and obese are risk factors for cerebral infarction, so maintain a healthy weight through a healthy diet and exercise.
9. Manage stress: Long-term stress may increase the risk of cardiovascular disease, seek effective stress management methods such as meditation, deep breathing, and relaxation techniques.
10. Regular check-ups: Regular check-ups can help detect and manage conditions that increase the risk of cerebral infarction early.
Lifestyle changes are an important part of preventing lacunar cerebral infarction, but medication may also be needed for certain people with a genetic predisposition or other pre-existing health conditions. It is crucial to follow your doctor's advice, get regular health check-ups, and take action if needed.
Lacunar cerebral infarction is a common cerebrovascular disease, and although the symptoms may be mild, if not treated and prevented in time, it can have serious effects on the patient's health. Therefore, we should improve our understanding of this disease and take proactive preventive measures to protect our brain health.