Neuro: Lacunar Stroke: Free MSRA Podcast

🧠 FREE MSRA PODCAST – Lacunar Stroke: The Small Vessel Stroke With Big Consequences🎧 Cut through the confusion on lacunar strokes: how to spot them, what causes them, and why vascular risk factors matter for brain health long-term.📝 Key Learning Points📌 Definition• Lacunar stroke = ischaemic stroke due to occlusion of small, deep penetrating arteries• Infarcts in deep brain structures: basal ganglia, thalamus, internal capsule, pons• Leaves small cavities (“lacunes”) after tissue dies and is reabsorbed📌 Causes & Risk Factors• Chronic hypertension (number one cause)• Diabetes mellitus• Hyperlipidaemia (high cholesterol)• Smoking• Obesity, sedentary lifestyle• Prior TIA or stroke• Rarely: embolism, vasculitis, genetic small vessel diseases📌 Pathophysiology• Chronic vascular risk factors → small vessel disease• Two key mechanisms: – Lipohyalinosis (degeneration & thickening of vessel wall) – Microatheroma (tiny plaque buildup in vessel)• Results in narrowed/blocked deep arteries, causing focal brain infarction📌 Clinical Features• Depend on the affected area, but classic lacunar syndromes include: – Pure motor hemiparesis (weakness one side, no sensory loss) – Pure sensory stroke – Ataxic hemiparesis – Dysarthria–clumsy hand syndrome• Cortical signs (aphasia, neglect, visual field loss) are typically absent📌 Differential Diagnosis• Large vessel strokes (often with cortical signs)• TIA• Intracerebral haemorrhage• Stroke mimics (migraine, seizure, metabolic issues)• Imaging essential: CT/MRI to confirm ischaemic, deep, small infarcts and exclude bleeds📌 Epidemiology• ~25% of all ischaemic strokes in the UK• Incidence increases with age and in those with vascular risk factors📌 Investigations• Imaging: MRI or CT to confirm lacunar infarct• Stroke workup: blood tests (glucose, cholesterol), ECG, vascular imaging (to assess risk factors and exclude embolic source)• Focus is on finding and treating the underlying cause to prevent recurrence📌 Management• Acute phase: Similar to other ischaemic strokes (thrombolysis if indicated/timely)• Long-term: – Aggressive risk factor control: lower BP, manage diabetes/cholesterol, stop smoking, encourage exercise/diet – Antiplatelet therapy (aspirin, clopidogrel) – Address underlying causes, monitor for recurrent stroke📌 Complications• Recurrent strokes (if vascular risks not addressed)• Persistent motor/sensory deficits• Cognitive decline & vascular dementia (especially with multiple lacunes)• Reduced functional independence📌 Prognosis• Often favourable for functional recovery after a single lacunar stroke• But: risk of further strokes and cognitive decline if risk factors not tightly managed• Multiple lacunes → “small vessel disease” on MRI, raises risk of vascular dementia📎 More MSRA Resources for Lacunar Stroke:📝 Revision Notes: https://www.passthemsra.com/topic/lacunar-stroke-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/lacunar-stroke-flashcards/💬 Accordion Q&A: https://www.passthemsra.com/topic/lacunar-stroke-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/lacunar-stroke-rapid-quiz/🎓 Neurology Course: https://www.passthemsra.com/courses/neurology-for-the-msra/#LacunarStroke #SmallVesselDisease #MSRARevision #NeurologyMSRA #MSRAQuiz #MSRAFlashcards #PassTheMSRA #VascularDementia #StrokeMedicine #IschaemicStroke #Cerebrovascular #StrokePrevention #Hypertension #VascularRisk