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423:(CT scan). Silent strokes, including silent lacunar infarctions, have been shown to be much more common than previously thought, with an estimated prevalence rate of eleven million per year in the United States. Approximately 10% of these silent strokes are silent lacunar infarctions. While dubbed "silent" due to the immediate lack of classic stroke symptoms, SLIs can cause damage to the surrounding brain tissue and can affect various aspects of a person's mood, personality, and
40:
133:
532:
More recent advances have also suggested these mechanisms may play a combined role in the aetiology of lacunar infarction. The most current theory indicates endothelial dysfunction and increased permeability of the blood-brain barrier first allow leakage of blood contents, promoting gliosis and white
414:
which usually shows no identifiable outward symptoms, and is thus termed "silent". Because stroke is a clinical diagnosis (that is, it is defined by clinical symptoms), there is debate about whether SLI are considered to be strokes, even though the pathophysiology is presumably the same. Individuals
325:
It displays a combination of cerebellar and motor symptoms, including weakness and clumsiness, on the ipsilateral side of the body. It usually affects the leg more than it does the arm; hence, it is known also as homolateral ataxia and crural paresis. The onset of symptoms is often over hours or
592:
Patients who have lacunar strokes have a greater chance of surviving beyond thirty days (96%) than those with other types of stroke (85%), and better survival beyond a year (87% versus 65-70%). Between 70% and 80% are functionally independent at 1 year, compared with fewer than 50% otherwise.
643:. The rehabilitation healthcare team should also educate the patient and their family on common stroke symptoms and how to manage an onset of stroke. Continuing follow-up with a physician is essential so that the physician may monitor medication dosage and risk factors.
580:
can be given within 48 hours. For long term prevention of recurrence, medical regimens are typically aimed towards correcting the underlying risk factors for lacunar infarcts such as hypertension, diabetes mellitus and cigarette smoking. Anticoagulants such as
533:
matter hyper-intensities on magnetic resonance imaging. Moreover, focal narrowing of brain vessels and impairment of their ability to dilate in response to various stimuli may lead to a decreased cerebral blood flow and ultimately lacunar stroke.
229:
Each of the five classical lacunar syndromes has a relatively distinct symptom complex. Symptoms may occur suddenly, progressively, or in a fluctuating (e.g., the capsular warning syndrome) manner. Occasionally, cortical infarcts and
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is believed to be the mechanism when there is stenosis of the penetrating artery. When no evidence of small vessel disease is found on histologic examination, an embolic cause is assumed, either artery-to-artery
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who have a SLI are often completely unaware they have had a stroke. This type of stroke often causes lesions in the surrounding brain tissue that are visibly detected via neuroimaging techniques such as
345:
The main symptoms are dysarthria and clumsiness (i.e., weakness) of the hand, which often are most prominent when the patient is writing; but dysarthria or involuntary movement can also be seen in legs.
110:
dissections of post-mortem stroke patients. He observed "lacunae" (empty spaces) in the deep brain structures after occlusion of 200–800 μm penetrating arteries and connected them with five classic
234:
can mimic lacunar infarcts, but true cortical signs (aphasia, visuospatial neglect, gaze deviation, and visual field defects) are always absent in lacunar strokes. The classic syndromes are as follows:
1304:
Mok, Vincent C.; Wong, Adrian; Lam, Wynnie W.; Baum, Lawrence W.; Ng, Ho Keung; Wong, Lawrence (2008). "A case-controlled study of cognitive progression in
Chinese lacunar stroke patients".
91:
that provide blood to the brain's deep structures. Patients who present with symptoms of a lacunar stroke, but who have not yet had diagnostic imaging performed, may be described as having
332:
548:
are risk factors. It is unclear whether there is an association with alcohol consumption, elevated cholesterol, or history of prior stroke. Lacunar strokes may result from
623:, bridging, long-sitting and kneeling for example) and learn to transfer safely (from their bed to a chair or from a wheel chair to a car for example). Assistance and
655:, with an annual incidence of approximately 15 per 100,000 people. They may be more frequent in men and in people of African, Mexican, and Hong Kong Chinese descent.
615:. When increases in activity are tolerated, and stability improvements are made, patients will progress from rolling to side-lying, to standing (with progressions to
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Marked by numbness (loss of sensation) on one side of the body; can later develop tingling, pain, burning, or another unpleasant sensation on one side of the body.
1261:
Sacco, S.; Marini, C.; Totaro, R.; Russo, T.; Cerone, D.; Carolei, A. (2006). "A population-based study of the incidence and prognosis of lacunar stroke".
443:
According to
Koffler et al., lacunes are derived from an "occlusion of a single deep penetrating artery that arises directly from the constituents of the
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or cardioembolism. In one recent series, 25% of patients with clinical radiologically defined lacunes had a potential cardiac cause for their strokes.
929:
Grau-Olivares, Marta; Arboix, Adrià ; Bartrés-Faz, David; Junqué, Carme (2007). "Neuropsychological abnormalities associated with lacunar infarction".
1014:. Koffler, Sandra,, Mahone, E. (E. Mark),, Marcopulos, Bernice A.,, Johnson-Greene, Douglas Eric, 1962-, Smith, Glenn E. New York, NY. 2018-12-17.
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556:. Patients often recover well, but if there is enough white matter disease from lacunar pathology, one can see a subcortical dementia such as
520:
of the penetrating artery (luminal atheroma), or atheroma involves the origin of the penetrating artery (junctional atheroma). Alternatively,
1202:"Trends in Incidence, Risk Factors, and Survival in Symptomatic Lacunar Stroke in Dijon, France, from 1989 to 2006: A Population-Based Study"
1200:
Bejot, Y.; Catteau, A.; Caillier, M.; Rouaud, O.; Durier, J.; Marie, C.; Di Carlo, A.; Osseby, G.-V.; Moreau, T.; Giroud, M. (2008).
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Tuo, H.; Tian, Z.; Ma, X.; Cui, Y.; Xue, Y.; Che, J.; Xu, C.; Chen, K.; Zhang, Y.; Zhang, L.; Bi, H.; Le, W.; Ondo, W. (2019).
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This lacunar syndrome involves hemiparesis or hemiplegia (weakness) with sensory impairment in the contralateral side.
336:(sometimes considered a variant of ataxic hemiparesis, but usually still is classified as a separate lacunar syndrome)
176:
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Giacomozzi, S.; Caso, V.; Agnelli, G.; Acciarresi, M.; Alberti, A.; Venti, M.; Mosconi, M. G.; Paciaroni, M. (2020).
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17:
723:"Lacunar stroke syndromes as predictors of lacunar and non-lacunar infarcts on neuroimaging: A hospital-based study"
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974:"Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: The Cardiovascular Health Study"
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may be administered within 3 to 4.5 hours of stroke onset if the patient is without contraindications (i.e. a
115:. These syndromes are still noted today, though lacunar infarcts are diagnosed based on clinical judgment and
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interventions are used in the rehabilitation of lacunar stroke. A physiotherapy program will improve joint
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that typically affects the face, arm, or leg of the side of the body opposite the location of the infarct.
165:
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aids are used as required as the patient begins walking and lessened as function increases. Furthermore,
839:"Clinical and radiological characteristics of restless legs syndrome following acute lacunar infarction"
342:, anterior limb or genu of internal capsule, corona radiata, basal ganglia, thalamus, cerebral peduncle
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427:. A SLI or any type of silent stroke places an individual at greater risk for future major stroke.
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Longstreth Jr, W. T.; Bernick, C; Manolio, T. A.; Bryan, N; Jungreis, C. A.; Price, T. R. (1998).
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Kohlhase, K.; Schaefer, J. H.; Lapa, S.; Jurcoane, A.; Wagner, M.; Hok, P.; Kell, C. A. (2021).
455:". Other lesions that are associated with lacunes appear in the "deep nuclei of the brain (37%
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1161:"The natural history of lacunar infarction: The Oxfordshire Community Stroke Project"
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770:"Cardioembolic Stroke: Clinical Features, Specific Cardiac Disorders and Prognosis"
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can be used to support limbs and joints to prevent or treat complications such as
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Regenhardt, Robert W.; Das, Alvin S.; Lo, Eng H.; Caplan, Louis R. (2018-10-01).
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Micheli, Sara; Corea, Francesco (2012). "Lacunar versus non-lacunar syndromes".
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475:(10%)". These lesions are less common within other brain regions such as the
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Histopathology of a small lacunar infarct discovered incidentally on autopsy.
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1063:"Lacunar Infarction and Small Vessel Disease: Pathology and Pathophysiology"
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1112:"Advances in Understanding the Pathophysiology of Lacunar Stroke: A Review"
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such as recent major surgery or cancer with brain metastases). High dose
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have shown no benefit over aspirin with regards to five-year survival.
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Neuropsychology : a review of science and practice, volume III
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It is estimated that lacunar infarcts account for 25% of all
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Much of the current knowledge of lacunar strokes comes from
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Bamford, J.; Sandercock, P.; Jones, L.; Warlow, C. (1987).
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now is thought to be the most common mechanism of arterial
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was thought to be the main small vessel pathology, but
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157:. Unsourced material may be challenged and removed.
479:, cerebral white matter and anterior limb of the
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552:pathology or microemboli from the heart as in
364:), internal capsule, corona radiata, midbrain
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674:"Aphasia associated with lacunar infarctions"
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1042:: CS1 maint: location missing publisher (
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217:Learn how and when to remove this message
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296:(second most frequent lacunar syndrome)
886:Frontiers of Neurology and Neuroscience
768:Arboix, Adria; Alioc, Josefina (2010).
255:(most common lacunar syndrome: 33–50%)
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1727:Partial anterior circulation infarct
931:Journal of the Neurological Sciences
155:adding citations to reliable sources
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1306:Clinical Neurology and Neurosurgery
471:(16%) or the posterior limb of the
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1722:Total anterior circulation infarct
1523:Posterior cerebral artery syndrome
1275:10.1212/01.wnl.0000210457.89798.0e
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314:, red nucleus, lentiform nucleus,
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1513:Anterior cerebral artery syndrome
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613:passive range of motion exercises
1896:Cerebral venous sinus thrombosis
516:in the parent artery blocks the
486:The two proposed mechanisms are
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1674:Anterior spinal artery syndrome
1518:Middle cerebral artery syndrome
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727:Internal and Emergency Medicine
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1679:Vertebrobasilar insufficiency
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439:Small arteries beneath brain.
253:Pure motor stroke/hemiparesis
79:) is the most common type of
1219:10.1161/STROKEAHA.107.510933
1128:10.1001/jamaneurol.2018.1073
570:tissue plasminogen activator
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855:10.1016/j.sleep.2018.06.004
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1648:Cerebellar stroke syndrome
1581:Lateral medullary syndrome
990:10.1001/archneur.55.9.1217
786:10.2174/157340310791658730
774:Current Cardiology Reviews
739:10.1007/s11739-019-02193-2
690:10.1007/s00115-021-01072-6
316:superior cerebellar artery
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1576:Medial medullary syndrome
1566:Brainstem stroke syndrome
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421:computed axial tomography
408:silent lacunar infarction
394:Silent lacunar infarction
373:Mixed sensorimotor stroke
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1755:Transient global amnesia
1602:Lateral pontine syndrome
1538:Dejerine–Roussy syndrome
1484:Cerebrovascular diseases
1061:Caplan, Louis R (2015).
320:anterior cerebral artery
232:intracranial hemorrhages
73:lacunar cerebral infarct
1846:Intracranial hemorrhage
1664:Carotid artery stenosis
1593:Medial pontine syndrome
1178:10.1161/01.STR.18.3.545
1079:10.5853/jos.2015.17.1.2
564:Treatment and prognosis
380:and adjacent posterior
93:lacunar stroke syndrome
50:of two lacunar strokes.
536:Advanced age, chronic
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333:Dysarthria/clumsy hand
1868:Intracranial aneurysm
1657:Extracranial arteries
1046:) CS1 maint: others (
978:Archives of Neurology
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425:cognitive functioning
410:(SLI) is one type of
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87:of small penetrating
83:, resulting from the
1804:Cerebral/Intra-axial
1750:Binswanger's disease
597:Occupational therapy
496:. At the beginning,
340:basilar part of pons
308:basilar part of pons
267:basilar part of pons
244:Location of infarct
151:improve this article
1891:Cerebral vasculitis
1769:Haemorrhagic stroke
1707:Cerebral infarction
554:atrial fibrillation
449:cerebellar arteries
352:Pure sensory stroke
1830:Duret haemorrhages
1427:External resources
574:bleeding diathesis
558:Binswanger disease
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294:Ataxic hemiparesis
123:Signs and symptoms
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1623:Benedikt syndrome
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1122:(10): 1273–1281.
1067:Journal of Stroke
1021:978-0-19-065256-2
907:978-3-8055-9911-5
898:10.1159/000333426
546:diabetes mellitus
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467:) as well as the
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18:Lacunar syndromes
16:(Redirected from
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1312:(7): 649–56.
1311:
1307:
1300:
1292:
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1269:(9): 1335–8.
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522:hypoperfusion
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168: –
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162:Find sources:
156:
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140:This article
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1794:Subarachnoid
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647:Epidemiology
637:contractures
609:paretic limb
595:
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538:hypertension
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161:
149:Please help
144:verification
141:
101:
96:
92:
76:
72:
68:
67:
1777:Extra-axial
1669:precerebral
568:Typically,
274:hemiparesis
1640:Cerebellum
1558:Brain stem
1486:including
1412:DiseasesDB
1073:(1): 2–6.
1030:1078637067
659:References
641:spasticity
625:ambulation
477:cerebellum
463:, and 10%
318:infarcts,
282:Dysarthria
278:hemiplegia
207:March 2022
177:newspapers
117:radiologic
1822:Brainstem
1597:Foville's
1436:eMedicine
1263:Neurology
1250:eMedicine
1038:cite book
892:: 94–98.
849:: 81–87.
826:eMedicine
755:202641797
621:quadruped
506:occlusion
322:infarcts
286:dysphagia
119:imaging.
113:syndromes
85:occlusion
61:Neurology
56:Specialty
1911:Category
1860:Aneurysm
1789:Subdural
1784:Epidural
1613:Midbrain
1334:33602657
1326:18456396
1283:16682663
1228:18436869
1146:30167649
1097:25692102
951:17316693
916:22377873
871:53713034
863:30458382
804:21804774
747:31535289
708:33591414
587:warfarin
527:embolism
514:atheroma
510:stenosis
461:thalamus
378:thalamus
358:thalamus
89:arteries
1839:General
1745:CADASIL
1571:Medulla
1406:D020520
1187:3590244
1137:7426021
1088:4325635
998:9740116
959:2768316
795:2994107
699:8342334
629:splints
607:of the
583:heparin
578:aspirin
542:smoking
518:orifice
465:caudate
457:putamen
302:of the
261:of the
191:scholar
108:cadaver
48:CT scan
1488:stroke
1441:pmr/63
1395:434.91
1332:
1324:
1291:494869
1289:
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1206:Stroke
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1165:Stroke
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745:
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696:
633:braces
611:using
459:, 14%
451:, and
326:days.
310:, and
193:
186:
179:
172:
164:
1884:Other
1738:Other
1505:Brain
1417:31186
1380:G46.7
1376:G46.5
1330:S2CID
1287:S2CID
955:S2CID
867:S2CID
751:S2CID
617:prone
241:Name
198:JSTOR
184:books
1588:Pons
1401:MeSH
1390:9-CM
1322:PMID
1279:PMID
1224:PMID
1183:PMID
1142:PMID
1093:PMID
1048:link
1044:link
1026:OCLC
1016:ISBN
994:PMID
947:PMID
912:PMID
902:ISBN
859:PMID
800:PMID
743:PMID
704:PMID
639:and
631:and
599:and
585:and
544:and
508:(or
490:and
469:pons
419:and
170:news
97:LACS
77:LACI
1386:ICD
1367:ICD
1314:doi
1310:110
1271:doi
1248:at
1214:doi
1173:doi
1132:PMC
1124:doi
1083:PMC
1075:doi
986:doi
939:doi
935:257
894:doi
851:doi
824:at
790:PMC
782:doi
735:doi
694:PMC
686:doi
417:MRI
362:VPL
276:or
153:by
106:'s
99:).
71:or
1913::
1604:/
1595:/
1439::
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1393::
1374::
1371:10
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1267:66
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1236:^
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406:A
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265:,
1476:e
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1462:v
1388:-
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1359:D
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