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Lacunar Stroke: Causes & Treatment

Instructor: Danielle Haak

Danielle has a PhD in Natural Resource Sciences and a MSc in Biological Sciences

You may be familiar with strokes, but what about lacunar strokes? These occur due to blocked blood flow in the tiniest arteries deep in your brain. In this lesson, we'll take a look at what causes these strokes and how they're treated.

What is a Lacunar Stroke?

When Jeff received a phone call that his dad had experienced a stroke, he left work immediately and headed to the hospital. By the time he got there, his dad had already received medication that put him out of immediate danger, but they still had to investigate what type of stroke he had and what caused it. After undergoing a series of imaging scans and blood work, the doctor reported that Jeff's dad had experienced a lacunar stroke, most likely caused by his hypertension, or high blood pressure. Now that they knew the type of stroke, they could begin to develop a treatment plan.

You've probably already heard about a stroke, but are you familiar with the different types of stroke that can occur? Let's dig in and learn a little more about lacunar strokes.

A stroke occurs when blood vessels in the brain become blocked or damaged, preventing oxygen-rich blood from being delivered to some of the brain's cells. If oxygen deprivation lasts too long, cells begin to die, causing permanent damage to the affected part of the brain.

Most often, blockages or damage occur in the arteries-- vessels responsible for transporting oxygen-rich blood from the blood to the body's cells. If a stroke is caused by a blood clot that gets stuck in an artery and stops blood flow, it's called an ischemic stroke. If a stroke is caused by a blood vessel bursting, it's called a hemorrhagic stroke.

Lacunar strokes, like the one Jeff's father experience, are a type of ischemic strokes caused by a blood clot blocking blood flow in an artery, specifically to the tiniest arteries found deep within the brain. These tiny arteries are usually end arteries found in various structures of the brain like white matter, the basal ganglia, or the pons. In fact, about 20% of ischemic strokes are lacunar strokes.

A lacunar stroke is caused when a blocked artery prevents blood from reaching the small arteries found deep within the brain.
Arteries of the brain

Causes of Lacunar Strokes

There are a number of risk factors that increase the likelihood of a person experiencing a stroke (any type). These include:

  • Age
  • Diabetes
  • Hypertension (high blood pressure)
  • Heart disease
  • Smoking
  • Poor diet and lack of exercise

The most common underlying cause of lacunar strokes is chronic hypertension, or long term high blood pressure. Over time, hypertension causes blood vessels to narrow, increasing the risk of a blood clot getting stuck and blocking blood flow. This explains why the doctor told Jeff and his dad that he believed hypertension was to blame in the scenario above.

Other causes of lacunar strokes include:

  • Atherosclerosis: a build up of fatty substances called plaque on the walls of arteries
  • Carotid artery disorder: a build up of plaque specifically in the carotid arteries
  • Irregular heartbeat: also known as atrial fibrillation, this condition can cause the blood to pool and clot

Treating Lacunar Strokes

Now that we know conditions that can cause lacunar strokes, how can these strokes be treated?

When someone experiences a stroke, it's critical they receive medical attention as soon as possible. The longer it takes to treat a stroke, the more permanent damage occurs. Immediate treatment is used to restore blood flow as soon as possible. This is most often done through the use of medication that breaks up blood clots. This medication can be taken orally or can be inserted directly into the brain through use of a catheter. Once blood flow is restored, a patient and doctor can begin evaluating long-term treatment options.

What types of long-term treatment options exist? Good question! Identifying and treating the underlying cause (like hypertension) can help prevent future strokes from occurring. Most of these underlying causes can be treated with medication and lifestyle changes. The type of medication depends on the cause, and the most common lifestyle changes are improved diet and exercise and quitting smoking.

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