What is a Lacunar Stroke? Let's talk about it simply!

Today we are going to talk about a serious condition that is very important to be aware of. You may have heard of a stroke. One of the most common types of stroke is a lacunar stroke. Simply put, this is a condition that occurs when a blood clot forms in a very small blood vessel in the brain. It is similar to a blocked water pipe that stops the flow of water.

Lacunar stroke occurs when the blood flow to a tiny blood vessel deep in the brain stops, or becomes blocked by a blood clot, causing damage to that part of the brain. This is a type of stroke called ischemic stroke . Doctors sometimes call it a lacunar infarction. The word 'infarction' means that when a tissue in the body loses its blood supply, that tissue dies. A stroke is anything that interrupts the flow of blood to the brain.

This is a life-threatening medical emergency , just like an accident. So if you or someone you know is experiencing symptoms of a stroke, call 911 (or your local emergency number) immediately . The sooner you get to the hospital and start treatment, the better your chances of saving a life. Every second counts.

What are the symptoms of a lacunar stroke?

The symptoms of lacunar stroke are very similar to other types of ischemic stroke. One or more of these may occur at once:

• Feeling of weakness or numbness on one side of the face and body.
• Difficulty speaking, slurring of words, and sometimes complete loss of speech (we call this 'aphasia' ).
• Slurred speech, stuttering (this is called 'dysarthria' ).
• Loss of muscle control on one side of the face (like the mouth being pulled to one side).
• The sudden weakening or loss of one or more of our five senses (sight, hearing, smell, taste, touch).
• Blurred vision, double vision ( diplopia ).
• Loss of balance and inability to control limbs, like a drunk person ( 'Ataxia' ).
• Feeling dizzy or vertigo.
• Nausea and vomiting.

If you suspect a stroke, remember this 'BE FAST' method!

It's helpful to remember these English letters that mean 'BE FAST' to quickly recognize if you or a loved one is experiencing the warning signs of a stroke. Let's take a look at what they are:

• B for Balance: See if you suddenly lose your balance. Do you have difficulty standing or walking?
• E for Eyes: Check for sudden loss of vision, blurring, or changes in vision in one or both eyes.
• F for Face: Ask them to smile. See if one or both sides of their face appear to be drooping. Is their mouth pulled to one side?
• A for Arms: Ask them to raise both arms. If they are having a stroke, one arm may fall down without being able to hold the other up.
• S for Speech: Check for slurring, stuttering, or difficulty finding the right words when speaking. Can you speak clearly when asked to say a simple sentence?
• T for Time: Time is of the essence! If you notice any of these symptoms , seek help immediately, which means calling 1990. If possible, note the time your symptoms started by looking at your watch or phone. Telling your doctor when your symptoms started can help them decide what treatment is best for you.

Let's also learn about 'Mini-Stroke'?

Sometimes a 'Transient Ischemic Attack' or 'TIA' can occur. Some people also call this a 'Mini-Stroke'. This is when you have symptoms similar to a stroke, but they go away after a short time (usually within 24 hours). However, this is a serious warning that a real stroke may be coming soon. A person who has had a TIA also needs immediate medical attention. It is not a good idea to simply ignore it.

What causes lacunar stroke?

Lacunar strokes, as I mentioned earlier, are caused by a blood clot blocking a small blood vessel deep in your brain. These areas of the brain are home to important centers that control our senses (feelings, vision, etc.) and movement, such as the Basal Ganglia and Thalamus .

There are several health conditions that can cause blood clots to form and cause lacunar strokes. For example:

• High blood pressure (Hypertension): This is the main and most serious risk factor . If you know that your blood pressure is high, it is essential to control it.
• Increased blood cholesterol levels (Hyperlipidemia): When 'bad' cholesterol increases, it can deposit inside blood vessels and clog them.
• Clotting disorders: Some people have a tendency for their blood to clot easily.
• COVID-19 infection: This can also be associated with blood clots in some cases.
• Infections that destroy body tissue: For example, in a severe infection like sepsis , pieces of dead tissue can collect in the blood and travel to the brain and become lodged.

Remember, high blood pressure is the biggest enemy of lacunar stroke. Talk to your doctor about your blood pressure and try to keep it at a healthy level.

Who is at higher risk of developing lacunar stroke?

Anyone can have a lacunar stroke, but some people are at higher risk. These include:

• People over 65 years of age.
• People of Black descent (this may be related to genetic and socioeconomic factors).
• People who smoke or use other nicotine-containing products (e.g. vaping).
• People who use drugs.

Also, people with certain medical conditions are at higher risk:

• People with a genetic mutation in the 'NOTCH3' gene (this is linked to a rare condition called CADASIL).
• People with heart rhythm irregularities such as atrial fibrillation (which can cause blood clots to form in the heart).
• Alcohol use disorder.
• For those who have 'atherosclerosis', a disease in which the walls of blood vessels become thick and stiff.
• Diabetes (Diabetes Mellitus).

How do doctors accurately diagnose a lacunar stroke?

A doctor will determine if you have a lacunar stroke by reviewing your symptoms, performing a neurological exam , performing a physical exam, and performing a few other special tests. If you are taken to the emergency room, the doctors there can make this diagnosis.

Doctors use tests like these to confirm that you've had a lacunar stroke:

• Blood tests: Check for things like blood clotting problems, diabetes, and cholesterol levels.
• CT scan: This can take pictures of the brain and quickly determine if there is bleeding or a blood vessel blockage.
• EEG (EEG - Electroencephalogram): Checks the electrical activity of the brain (may be necessary in some cases).
• ECG (Electrocardiogram): Check for irregular heartbeats and signs of a heart attack.
• MRI: This can produce clearer, more detailed images of the brain. This is very important for accurately assessing the damage to the brain caused by a stroke.

What are the treatments for lacunar strokes?

The most important thing when treating a lacunar stroke is to restore blood flow to the brain as quickly as possible. Doctors do this as quickly as possible because it reduces the risk of permanent brain damage and death.

There are two main treatment methods:

• Thrombolytic therapy: These are medications that dissolve blood clots. They are most often given within four and a half hours of the onset of symptoms, because if given later, there is a greater risk of dangerous bleeding inside the body.
• Mechanical thrombectomy: This is a surgical procedure to remove the blood clot. The surgeon inserts a small, thin tube (catheter) into a blood vessel elsewhere in your body and threads it into the blood clot in your brain. The clot is then either sucked out all at once or broken into pieces and sucked out. However, in many lacunar strokes, the affected blood vessel may be too small to perform this thrombectomy. Your doctor and surgeon will tell you what is best for your situation.

In addition to this, you may need other treatments:

• Blood thinners: Anticoagulant medications prevent your blood from clotting easily. These may also be given after thrombolytic therapy.
• Controlling blood pressure: Doctors prescribe medication to control your pressure and keep it at a safe level.

Is rehabilitation important after a stroke?

Yes, absolutely! Rehabilitation is a very important part of treatment after a stroke. This rehabilitation treatment helps you adjust to the changes that have happened to your brain and body because of the stroke. You may need help to regain the abilities you had before the stroke, or to adjust to living with new disabilities. You may need one or a combination of these treatments:

• Speech therapy: This can help improve your language skills, the way you speak, and control the muscles that help you speak, breathe, eat, and swallow. Antiplatelet medications are often needed after a lacunar stroke.
• Physical therapy: This can help strengthen your muscles, improve your balance, and regain the use of your arms and legs.
• Occupational therapy: This helps you safely perform your daily activities, especially tasks that require fine movements (e.g., eating, dressing, writing).
• Cognitive rehab: This helps improve your memory, attention span, and other mental abilities.

What is the life expectancy after a lacunar stroke? Is it possible to fully recover?

The number of people surviving a stroke is increasing, thanks to improved, faster treatments. But it's hard to say for sure whether there's a one-size-fits-all recovery schedule or outlook.

Lacunar strokes (and other types of 'ischemic strokes') generally have a higher survival rate than hemorrhagic strokes , which are caused by bleeding in the brain. But that doesn't mean you'll necessarily survive any longer than others.

Everyone's body responds differently to a stroke. What "complete recovery" means to you may be different from what it means to someone else. You may regain full function of your brain and body, but you may also develop new or different disabilities after a lacunar stroke.

What you can expect depends on several things:

• your age.
• How quickly the stroke was treated.
• Your overall health.

Most people take several months to recover. Your doctor will tell you what to expect. He or she will help you set your recovery goals and expectations based on your own health.

Can a lacunar stroke be prevented?

Yes, very much so! Maintaining good overall health is the best way to prevent lacunar stroke. Try to do these things:

• Keep your blood pressure, cholesterol levels, and other medical conditions (e.g., diabetes) under control. Take your medications as prescribed by your doctor.
• Eat more healthy foods (vegetables, fruits, legumes, and fiber). Maintain a healthy weight that suits you.
• If you smoke, stop. Stay away from other nicotine-containing products.
• Get regular physical exercise. Do something like walking for at least 30 minutes a day.

Have a medical checkup every year (or as your doctor recommends). Many diseases and problems that can cause lacunar strokes develop gradually over time. You may not notice any symptoms. Your doctor can help you recognize these warning signs early and help you manage them.

How do I take care of myself after a stroke?

Recovering from a stroke and going through rehabilitation programs is not easy, it's a lot of work. Once you and your doctor have developed a treatment plan, follow it as closely as possible. In general, you should do the following:

• Take your medications exactly as prescribed. This is especially important if you are taking blood thinners. It is important to reduce the risk of future blood clots, and taking your medications as prescribed by your doctor will help your body heal.
• Keep your rehab and other treatment appointments. Tell your therapist if anything makes you feel uncomfortable or unsafe. Rehabilitation is hard work, but you don't have to be in pain or discomfort all the time.
• Think about your mental health too.Depression and anxiety are common after a stroke. Your mental health is just as important as your physical health. Feeling sad or anxious does not make you weak or a failure. If you are feeling overwhelmed by something during your recovery, talk to your doctor or a mental health counselor .

What foods and drinks should I avoid?

Your doctor may suggest adding or removing certain foods from your diet. He or she may also recommend making small changes to your daily routine to help manage your medical conditions and/or reduce your risk of developing blood clots in the future after a lacunar stroke.

Foods that are generally advised to be avoided are:

• Alcohol
• Caffeine-rich drinks (it would be better if you could reduce your intake of tea and coffee)
• High-sugar foods (sweet foods, drinks)
• Foods high in salt (sodium) (reduce salt in foods, avoid processed foods that are high in salt)
• Fried foods
• Highly processed foods (e.g. sausages, meatballs, packaged foods)

When do I need to go to the Emergency Department (ETU) again?

If you feel like you are having another stroke, call 911 (or your local emergency number) immediately. Another stroke is more likely to cause serious complications and even death. Don't delay in seeking help or going to the emergency room.

People who have had a lacunar stroke are at increased risk of developing more serious complications. For example:

• Deep Vein Thrombosis (DVT) (blood clots in the deep veins of the legs)
• Heart attack
• Pneumonia
• Pulmonary embolism ( blood clot in a blood vessel in the lungs)
• Seizures

If you experience symptoms of any of these complications, you should call emergency services or go to the emergency room immediately.

What questions should I ask my doctor?

When you see your doctor, don't hesitate to ask any questions you have. Here are some things you might want to ask:

• 'Where exactly in my brain did I have this lacunar stroke?'
• 'What disease or problem caused this?'
• 'What kind of medicine do I need, and how should I use it?'
• 'What changes do I need to make in my daily life?'
• 'What else should I do to prevent me from having another stroke?'
• 'How long will my rehabilitation program last? What results can I expect?'

Finally, a few things to remember

Lacunar stroke (also called a 'lacunar infarct') is a condition that affects the tiny blood vessels deep in your brain, but it can have a big impact on your health. That's why it's important to have regular checkups. Your doctor can help you identify and manage health problems (such as high blood pressure, cholesterol, and diabetes) that increase your risk of stroke over time. Talk to your doctor about the best ways to manage the risk factors you've identified.

As you recover from a stroke, don't forget to celebrate even the small improvements you make. Some days you may not feel like it, but any success is worth celebrating. You can be proud of the hard work you put into your rehabilitation.

I hope this information is useful to you. Stay healthy!

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