Lacunar Stroke Syndromes
The term “lacunar” refers to the brain stem, which includes the brainstem and spinal cord. The word “stroke” refers to damage or injury to any part of the body. There are three major types of lacunar strokes:
1) Acute Lacunar Stroke (also called acute ischemic attack).
This type of stroke occurs suddenly and causes symptoms within minutes. Symptoms may include confusion, weakness, dizziness, loss of balance and coordination, numbness or tingling in your face or arms/hands, trouble speaking or understanding words, problems with vision and hearing. These symptoms usually last less than two hours but can persist for several days.
2) Subacute Lacunar Stroke (also called subacute ischemic attack).
This type of stroke occurs gradually over weeks or months. Symptoms may include memory loss, difficulty concentrating, fatigue, depression and irritability. These symptoms usually last longer than one month but can persist for several years.
3) Chronic Lacunar Stroke (also called chronic ischemic attack).
This type of stroke affects many parts of the body at the same time. This can result in severe nerve damage, weakness, and paralysis.
Lacunar Ischemia: This condition is often caused by blockages of small blood vessels (or “micro-strokes”) in the brain. It is the most common type of stroke suffered by people between the ages of 40 and 60. Most people who have lacunar infarcts have no warning signs or symptoms before the event. The stroke progresses slowly, over a period of hours or days. The effects are specific to the area of the brain that is experiencing ischemia (lack of oxygen and nutrients).
Symptoms can include headaches, changes in vision, weakness or paralysis on one side of the body and problems speaking or understanding language.
Lacunar Infarcts: Also called “micro-strokes,” these tiny areas of dead brain tissue are caused by blockages in the small blood vessels (arteries) of the brain. Most people who suffer one or more lacunar infarcts experience no warning signs or symptoms before the event. A person may have multiple lacunar infarcts without any noticeable weakness, paralysis or other symptoms. In fact, some people have multiple lacunar infarcts and never suffer any apparent effects.
Acute Ischemic Attack: An ischemia or lack of blood flow to the brain that causes sudden neurological symptoms. These attacks may or may not lead to a stroke. An acute ischemic attack may be a sign that a blood clot or other blockage is present in an artery supplying the brain. This condition is also known as a “mini-stroke”.
Stroke: A “brain attack” is a medical term used to describe a sudden loss of neurologic function caused by an interruption of blood flow to the brain, usually due to blockage of a cerebral artery by a clot (ischemic stroke), or rupture of a cerebral blood vessel causing bleeding into the brain (hemorrhagic stroke).
If an ischemic stroke is not treated within three hours of its onset, it can result in permanent brain damage or death.
Stroke onsets are classified according to the symptoms that appear:
Ischemic Stroke Onset “Watch-Out-For” Symptoms : (Also called “Transient Ischemic Attack”, or “TIA”.)
Sudden, unusual ringing or buzzing in one ear (usually the left ear).
Sudden dimness or loss of vision in one eye.
Sudden weakness or paralysis in any part of your body.
Sudden severe or unusual headache, especially if it is a new occurrence.
If you experience one of these symptoms, you should immediately call your physician and/or go to an emergency care hospital facility.
Stroke Onset “Signs” : (Also called “Attacks” or “Severe Strokes”.)
Sudden weakness of the face, arm or leg, especially on one side of the body.
Sudden difficulty speaking or understanding speech.
Sudden dimness or loss of vision in one or both eyes.
Sudden severe, sharp headache with no known cause.
Loss of balance or coordination.
Sudden fall, especially with no obvious cause.
Unable to move one or more parts of your body, especially on one side of the body.
Stroke Onset “Symptoms” : (Also called “Symptoms” or “Minor Strokes”.)
Numbness or weakness in face, arm or leg, especially on one side of the body.
Problems speaking or understanding speech.
Problems reading or recognizing familiar objects.
Blindness in one or both eyes, even when wearing glasses.
Difficulty walking, numbness, or loss of balance or coordination.
Headache with no known cause, especially if it progresses to the above symptoms.
Generalized weakness, headache or nausea that lasts for more than a few minutes or a general ongoing ill feeling for hours or days (sometimes weeks) with no known cause.
Difficulty in swallowing or “feeling funny”
If you experience one or more of these symptoms, especially if they are new or worsening, you should immediately call your physician and/or go to an emergency care hospital facility.
You should also contact your physician if a relative or friend experiences any of the above symptoms. If they are visiting you, take them to an emergency care hospital facility. If they are a patient of yours, have them contact their physician immediately.
The faster a person experiencing a stroke or “mini-stroke” receives treatment, the less severe their damage will be. Even if a stroke seems to have no effect, the patient should still follow-up with their physician as soon as possible because often there are no symptoms but underlying damage has occurred.
Possible Complications from a stroke, or “mini-stroke” may include:
Injury to an arm or leg.
Difficulty in speaking or understanding speech (such as aphasia).
Problems with vision, such as blurriness, double vision, loss of vision, or partial blindness.
Dizziness, loss of balance or coordination.
Numbness, tingling, pain or paralysis in any part of the body.
Aphasia
Aphasia is any loss of ability to communicate using speech or writing (which can also include not being able to understand spoken or written language), often caused by injury to the parts of the brain that contain language. It can be either expressive aphasia where the patient can no longer communicate, or receptive aphasia where the patient can still hear and understand others but cannot speak or write (or both).
In most cases, expressive aphasia is caused by injury to the Broca’s area of the brain, and receptive aphasia is caused by injury to the Wernicke’s area of the brain. These terms are somewhat relative since either injury can also cause the other type of aphasia depending on their location in the brain and size of the injury (some people have mixed forms).
In expressive aphasia the patient will often be unable to speak at all, or will only be able to utter a few speechless sounds. People with expressive aphasia may not be able to write comprehensible language either, and will only be able to utter a few syllables, nonsense words or continually repeat the same word (“te te te…” for example).
In receptive aphasia the patient will usually be able to speak but will have great difficulty in understanding spoken or written language. They may be able to repeat words or sentences (relying on rote memory) but will not understand what they mean. For example they may be able to correctly repeat a sentence such as “The girl walks to the store” but they would have no idea what it means because they do not have the required comprehension to assign meaning to the words they say.
At least one type of aphasia is present in up to half of all stroke victims; about 15% of these are severe cases. The most common type of expressive aphasia is anomia in which the patient cannot find the words they want to say. They know what they want to express but cannot find the words. Other types of expressive aphasia include Broca’s aphasia and global aphasia.
Receptive aphasia is often harder to recognize in patients since it can be masked by the patient also having expressive aphasia. In receptive aphasia, the problem is receiving, not producing language. The patient may be able to speak in long sentences and use complex grammar but not communicate anything meaningful – similar to aagrams in written language.
There are many types and sub-types of aphasia depending on the area of the brain that is damaged but the most common are:
Anomia – The inability to find words when speaking or writing.
Anomic Aphasia – Anomia caused by injury to the frontal lobe.
Broca’s Aphasia – Inability to speak caused by injury to the motor cortex of the brain. Patients are able to understand what is said to them but have difficulty forming words and sentences to respond. They can also have trouble with writing and have great difficulty reading and writing.
Conduction Aphasia – An injury or illness affecting the parts of the brain that relay information to and from the auditory and vocal cords, causing the patient to have great difficulty in speaking. Difficulty is experienced not only with spoken language but also in understanding it when heard.
Global Aphasia – Total loss of all language; reading, writing, speaking and understanding. This condition is very rare and is almost always caused by damage on both sides of the brain.
Mixed Aphasia – Combination of two or more types of aphasia, for example anomia with Broca’s aphasia.
Transcortical Aphasia – Similar to Wernicke’s aphasia in that the patient has great difficulty understanding and producing spoken and written language but can still write legible sentences, unlike Wernicke’s aphasia.
Wernicke’s Aphasia – Difficulty in producing spoken and written language. The patient makes up words or “grammarize” (inventing words or using incorrect homonyms in place of real words) when trying to speak or write. They also have difficulty understanding language and will have great difficulty with reading and writing.
“Word Salad” is a term used to describe incomprehensible speech; when someone talks nonsense, such as combining real words and/or made up words and sentences that do not follow the rules of grammar.
Speech Pathology is the practice that deals with aphasia and other communication disorders. Those that work in this field are called speech pathologists or speech therapists. Their goal is to help patients regain lost skills and learn to cope with ongoing disabilities.
An example of aphasia recovery would be someone who has experienced anomia. They would begin by associating known words that are similar to the word they want to say. If they were having trouble saying the word “pencil” they might instead say “writing stick” or “pointed wood”. Then a therapist might help them learn shortcuts for certain commonly used words or phrases, like “I don’t know” or “Stop that”. Finally, a speech pathologist could teach the patient tricks to make communication easier such as using pictures or gestures.
Sources & references used in this article:
Lacunar stroke by A Arboix, JL Martí-Vilalta – Expert review of neurotherapeutics, 2009 – Taylor & Francis
What causes lacunar stroke? by JM Wardlaw – 2005 – jnnp.bmj.com
Is breakdown of the blood-brain barrier responsible for lacunar stroke, leukoaraiosis, and dementia? by JM Wardlaw, PA Sandercock, MS Dennis, J Starr – Stroke, 2003 – europepmc.org
Lacunar stroke is associated with diffuse blood–brain barrier dysfunction by JM Wardlaw, F Doubal, P Armitage… – Annals of Neurology …, 2009 – Wiley Online Library
Effects of clopidogrel added to aspirin in patients with recent lacunar stroke by sPs3 Investigators – New England Journal of Medicine, 2012 – Mass Medical Soc
Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial by SPS3 Study Group – The Lancet, 2013 – Elsevier
