Lacunar Stroke Guide: Causes, Symptoms and Treatment Options

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What Is It?
Strokes can damage brain tissue in the outer part of the brain (the cortex) or deeper
structures in the brain underneath the cortex. A stroke in a deep area of the brain (for
example, a stroke in the thalamus, the basal ganglia or pons) is called a lacunar stroke .
These deeper structures receive their blood flow through a unique set of arteries.
Because of the characteristics of these arteries, lacunar strokes happen a little bit
differently from other strokes.
A lacunar stroke occurs when one of the arteries that provide blood to the brain's deep
structures is blocked. These arteries are small, and are uniquely vulnerable. Unlike most
arteries, which gradually taper to a smaller size, the arteries of a lacunar stroke branch
directly off of a large, high-pressure, heavily muscled main artery. High blood pressure
(hypertension) can lead to lacunar strokes because it causes a pounding pulse. Since the
arteries don't gradually taper down in their size, high blood pressure can directly damage
these arteries. High blood pressure also can cause atherosclerosis, a condition in which
fatty deposits (plaques) build up along the walls of blood vessels. When atherosclerosis
is present, a clot can form inside of one of these small arteries, blocking blood flow in the
artery.

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Unlike strokes that damage the cortex, lacunar strokes are only rarely caused by a blood
clot (also called a "thrombus") that forms elsewhere in the body, such as the neck or
heart, and travels through the bloodstream to the brain. After a clot (or any debris) begins
to travel through the bloodstream it is called an embolus. It is difficult for an embolus to
make its way into the small arteries that can cause a lacunar stroke.
Many of the deep brain organs that can be injured by a lacunar stroke help to relay
communication between the brainstem and the brain cortex, or help to coordinate
complicated body movements. In a lacunar stroke, brain cells in a relatively small area
(measuring from 3 millimeters to as much as 2 centimeters across) are damaged or killed
by lack of oxygen. Such a small area of brain destruction is called a lacune. A lacunar
stroke involves only a small area of the brain, but it can cause significant disability.
Lacunar strokes account for about 20 percent of all strokes in the United States.

Symptoms
The symptoms of lacunar stroke vary depending on the part of the brain that is deprived

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Symptoms can include:

Weakness or paralysis of the face, arm, leg, foot or toes
Sudden numbness
Difficulty walking
Difficulty speaking
Clumsiness of a hand or arm
Weakness or paralysis of eye muscles
Other neurological symptoms
In a person with prolonged, untreated high blood pressure, multiple lacunar strokes can
occur. This can cause additional symptoms to develop, including emotional behavior and
dementia.
The sudden appearance of one or more of these symptoms is a warning sign that a
stroke may be in progress. Sometimes, the small clots that can cause a lacunar stroke
interfere with blood flow only for a few minutes. If the clot dissolves before damage is
done, then symptoms can begin to improve within minutes and may go away completely.
When symptoms go away without treatment and full recovery occurs within 24 hours, the
event is called a transient ischemic attack (TIA). Never decide to wait and see whether
stroke symptoms will go away on their own. Get to an emergency room as quickly as
possible to get treatment.

Diagnosis
Your doctor will ask about your medical history (high blood pressure, heart disease,
smoking, high cholesterol and diabetes). He or she will check your vital signs
(temperature, pulse, breathing rate and blood pressure) and might order an
electrocardiogram (EKG).

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Expected Duration
If your symptoms continue without improvement during the time you are traveling to an
emergency center, it is best to assume that your event is a full-blown stroke, not a TIA. If
a lacunar stroke is treated early, full recovery is possible. If medicines restore circulation
to the brain quickly, symptoms of a lacunar stroke may go away within hours. If blood
supply is interrupted for a longer time, brain injury may be more severe, and symptoms
may last for many weeks or months, requiring physical rehabilitation. There may be
permanent disability.

Prevention
You can help to prevent lacunar stroke by preventing or controlling the risk factors for
stroke high blood pressure, smoking, heart disease and diabetes. If you have high
blood pressure or heart disease, follow your doctor's recommendations for modifying
your diet and taking your medication. Exercise regularly, eat plenty of fruits and
vegetables, and avoid foods filled with saturated fats and cholesterol. If you smoke, quit.
If you have diabetes, monitor your blood sugar level frequently, follow your diet, and take
your insulin or oral diabetes medication as your doctor has prescribed.
If you have had a lacunar stroke, your doctor may recommend a daily aspirin or other
blood-thinning medication, such as ticlopidine (Ticlid) or clopidogrel (Plavix). These
medicines may reduce your risk, but their benefit has been more obvious for stroke types
other than lacunar strokes. If you have never had a stroke of any kind, you might lower
your risk for a first stroke if you take a daily aspirin. There is strong evidence that stroke
risk is reduced for women over the age of 45 who take aspirin once every other day. This
benefit has not been proven for men.

Treatment
If doctors are able to provide treatment within three hours after symptoms start, they

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A person who has had a lacunar stroke usually is hospitalized so that he or she can be
observed in case symptoms worsen. A person with a severe stroke may need help with
self-care or feeding. In the hospital, an occupational therapist and a physical therapist
can help the person to work around a new disability and to regain strength after brain
injury. Commonly, hospitalization is followed by a period of residence at a rehabilitation
center, where additional intensive therapy may be given. The goal of rehabilitation is to
maximize recovery. To prevent future strokes, it is very important for you to control high
blood pressure. It helps to take a daily aspirin or other blood-thinning medication
(ticlopidine or clopidogrel).

When To Call a Professional

Call for emergency treatment immediately whenever the symptoms of lacunar stroke
occur, even if these symptoms last only a few minutes. For best results, stroke treatment
must occur within three hours of the start of symptoms.

Prognosis
People often begin to recover within hours or days of a lacunar stroke. Lacunar strokes
have a better rate of recovery than other strokes that involve larger blood vessels. More
than 90 percent of people with a lacunar stroke will recover substantially within the first
three months following the stroke.

Learn more about Lacunar Stroke

Symptoms and treatment for:
Heat Stroke (Hyperthermia)
Hemorrhagic Stroke
Intracranial Aneurysms

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Thrombotic Stroke
Transient Ischemic Attack (TIA)

External resources
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone: 301-496-5751
Toll-Free: 1-800-352-9424
TTY: 301-468-5981
http://www.ninds.nih.gov/
National Stroke Association
9707 E. Easter Lane
Englewood, CO 80112
Phone: 303-649-9299
Toll-Free: 1-800-787-6537
Fax: 303-649-1328
http://www.stroke.org/

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