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Stroke

Lacunar stroke?

03/07/2007

Question:

Hi:

My question is a little on the strange side, but my father recently has had a stroke (the night morning of February 25-26th) of which we are told is a stroke in progress to this day. CT, MRI, and MRA have been completed and are evaluated as progressive infarctive (pons area) with stenosis at the carotid siphons (85% and 95%). The doctors are treating it like an anamalous Brain Stem Stroke although the following are the current conditions: He is still conscious, cognitive, can speak, and eat machined food with the main deficits being motor and strength issues on the left side (essentially hemiplegia with foot drop) with recurrent strong headaches).

Given the situation, is it possible that the stroke was lacunar in nature and that he is expressing "Pure Motor Hemiplegia Syndrome" as defined by Fischer and Curry? With the MCA and ACA getting decreased bloodflow due to the carotid siphon occlusions, I am sure that there is more going on, but should the lacunar deficits be ruled out?

I appreciate any answers to this or guidance towards other research. I would be able to ask the doctor at the hospital myself but they are 6 states away in the middle of the rural midwest.

Answer:

Once the stroke has occurred, and brain tissue has been irreversibly injured, the stroke is "done", unless there are ongoing blood flow problems that could cause more damage.  I cannot predict if there will be further progression in your loved one's condition, but I doubt it unless a second event occurs.

A lacunar infarct refers to a small infarct within the deep structures of the brain.  The pure motor hemiplegia syndrome classically refers to a lesion farther up, in the deep white matter of the brain (in the internal capsule), although pontine lesions can cause the same type of problem. 

Whether this represents a lacunar stroke or not is really not important in terms of what we do to prevent another event or what we do to help the patient recover.  The only reason to "classify" strokes in this manner is that we can provide more information to families about prognosis.

The pure motor hemiplegia involving the internal capsule tends to have a higher likelihood of good recovery to independence than many other strokes.  Unfortunately, strokes in the pons are statistically less likely to make a full recovery to independence.

I wish you and your loved one the best.

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati