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What's the difference between a lacunar infarction and ischemic small

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Posted on Mon, 18 Mar 2019
Question: What's the difference between a lacunar infarction and ischemic small vessel changes in the brain.
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Answered by Dr. Olsi Taka (3 hours later)
Brief Answer:
In lacune there is complete occlusion of vessel with infarction, cell death

Detailed Answer:
Hello and welcome to HealthcareMagic!

Lacunar infarction and the ischemic small vessel changes seen in the deep white matter are both due to small vessel involvement, in fact they are usually grouped together in what is called small vessel disease and can often be see together in many patients.

What distinguishes them from each other is that in a lacunar infarction due to an occlusion of a small vessel an infarct happens, meaning that a group of cells have died, leaving a void, a fluid filled cavity in their place.
In the more diffuse white matter changes, the ischemic small vessel changes mentioned in the CT report, there is chronic low blood supply, which doesn't lead to infarction, acute nerve cell death, but gradual widespread damage to the myelin sheath around the axons, the long nerve fibers which convey signals from the nerve cells (the white matter consists mainly from these axon bundles traveling to and from the grey matter which contains most of the nerve cells bodies). As a result there is impaired integrity and functioning of the axons.

I hope to have been understandable enough. Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (3 hours later)
What if any symptoms might a person experience with new ischemic changes ? Will this continue?
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Answered by Dr. Olsi Taka (11 hours later)
Brief Answer:
Read below

Detailed Answer:
The symptoms are often subtle and depend on the degree of the changes. If mild there are usually no symptoms at all and even in the case of moderate changes symptoms may be subtle and be missed. The more severe the more likely for some changes to be noticed, a drop in cognitive functions (judgment, planning, language, memory)as well as walking and balance issues.

The question whether it will continue depends on the cause. In most cases it is a common issue with age which progresses as the years go by, depending on genetic factors as well as vascular risk factors such as diabetes, hypertension, smoking etc.
Your case is different though, in your case it is most probably not related to these age related changes but due to hydrocephalus. The damage to the axons may not be due to narrowing of blood vessels but due to pressure increase and fluid transudation in the white matter around the ventricles. The fact that the CT report says that there hasn't been any changed compared to previous imaging would support that. So in this case it won't necessarily continue, if there is no increase in pressure it may remain stable.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (8 hours later)
Would this cause spastic hemi paresis and muscle atrophy and supination?
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Answered by Dr. Olsi Taka (19 hours later)
Brief Answer:
Lacunar infarction may cause spastic hemiparesis.

Detailed Answer:
Hello again!

Lacunar infarction may cause spastic hemiparesis, not necessarily, it depends on the location, the damaged nerves, but potentially it can cause spastic hemiparesis. I do not see any lacunar infarction mentioned in that CT report though.
White matter small vessel ischemic changes on the other hand do not cause spastic hemiparesis, the limbs may have some rigidity, but on both sides, not spastic hemiparesis. Muscle atrophy is not common either.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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Practicing since :2004

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What's the difference between a lacunar infarction and ischemic small

Brief Answer: In lacune there is complete occlusion of vessel with infarction, cell death Detailed Answer: Hello and welcome to HealthcareMagic! Lacunar infarction and the ischemic small vessel changes seen in the deep white matter are both due to small vessel involvement, in fact they are usually grouped together in what is called small vessel disease and can often be see together in many patients. What distinguishes them from each other is that in a lacunar infarction due to an occlusion of a small vessel an infarct happens, meaning that a group of cells have died, leaving a void, a fluid filled cavity in their place. In the more diffuse white matter changes, the ischemic small vessel changes mentioned in the CT report, there is chronic low blood supply, which doesn't lead to infarction, acute nerve cell death, but gradual widespread damage to the myelin sheath around the axons, the long nerve fibers which convey signals from the nerve cells (the white matter consists mainly from these axon bundles traveling to and from the grey matter which contains most of the nerve cells bodies). As a result there is impaired integrity and functioning of the axons. I hope to have been understandable enough. Let me know if I can further assist you.