Multiple lacunar infarctions

Many phenomena show that in real society, many people suffer sudden physical illnesses due to certain reasons, and sometimes even die on the spot. Many celebrities died due to sudden heart attacks and failed rescue efforts, including our favorite teacher Gao Xiumin. These are things we cannot predict or avoid. No one wants to get sick, so it depends on our daily prevention.

Multiple lacunar infarction is one of these diseases, and it is also a very scary disease. If not treated in time, it will affect life. Life is very precious, because we only have one life and there is no chance to start over. So, let me explain what multiple lacunar infarction is.

Multiple lacunar infarctions are relatively common in clinical practice. Like single lacunar infarctions, they are a special type of cerebral infarction (cerebral thrombosis, cerebral embolism, lacunar infarctions, multiple cerebral infarctions, transient ischemic attacks), which often occur in the basal ganglia. On the basis of hypertension and arterial infarction, tiny arteries deep in the brain become occluded, causing ischemic softening of brain tissue. The lesion size is generally 2-20 mm, with 2-4 mm being the most common.

Common causes of multiple lacunar infarctions are as follows:

1. Hypertension: Hypertension is the most important direct cause of this disease, especially chronic hypertension. When it exceeds 21.3/12.7 kPa (160/95 mmHg), the literature reports that the incidence of hypertension in patients with lacunar infarction is 45% to 90%, and the effect of increased diastolic blood pressure on this disease is more obvious.

There are two possible mechanisms by which hypertension leads to lacunar infarction: ① Persistent hypertension acts on the walls of the deep penetrating arteries or other micro-arteries in the brain, increasing vascular permeability, hypercoagulation and weakened anticoagulation, leading to changes such as segmental fat hyaline, degenerated fibrin necrosis and microaneurysm in the microvascular wall, resulting in small artery obstruction and microembolism. ②Persistent hypertension causes the basilar artery of the brain to stretch, the deep penetrating arteries to shift and twist, and the lateral blood flow to further decrease, resulting in ischemic microinfarction.

2. Arteriosclerosis: Lacunar infarction is closely related to arteriosclerosis. Fisher used the method of continuous sectioning to observe and confirm that the blood supply arteries to the lacunar lesions in the internal capsule region of the basal ganglia had severe cerebral arteriosclerotic changes, namely, segmental arterial structural destruction, fibrinoid necrosis or vascular necrosis. Other scholars have also found that the obvious changes in the medullary arteries are hyaline thickening of the vessel wall and narrowing of the vascular lumen. The frequency of lacunar infarction in various brain regions is proportional to the degree of arteriosclerosis.

3. Diabetes: It is well known that diabetes can cause small artery infarction in the distal limbs, kidneys, peripheral nerves of the retina and cranial nerves, but the effect of diabetes on small vessel disease in the brain has not yet been clearly located. Epidemiological survey results show that diabetes is one of the risk factors for stroke, but there is still a lack of evidence linking diabetes and lacunar infarction. The study by Mast et al. also confirmed that diabetes was associated with multiple lacunar infarctions, but not single lacunar infarctions. However, the increased coagulability and viscosity of the blood and the enhanced platelet adhesion in diabetes will undoubtedly increase the blood supply to the deep perforating arteries of the brain, playing an important role in the formation of lacunar cerebral infarction.

4. Emboli (1) Cardiogenic embolus: detachment of mural emboli from rheumatic heart disease or non-rheumatic heart disease. (2) Arterial emboli: including thrombi from atherosclerosis with or without ulcers, fibromuscular vascular disease, and dissecting aneurysms, especially emboli formed by the detachment of atherosclerotic plaques in the ascending aorta and carotid arteries. It is one of the important causes of lacunar cerebral infarction and has attracted increasing attention.

5. Other factors: hyperlipidemia, hyperviscosity, smoking, drinking and changes in local cerebral blood flow also have a certain impact on the occurrence of lacunar cerebral infarction.

Symptoms of multiple lacunar infarctions include dizziness, headache, limb numbness, vertigo, memory loss, slow reaction, convulsion, dementia, unconsciousness. Psychiatric symptoms are rare. The main clinical signs are: tongue stiffness, slowed speech, changes in voice and tone, mild central facial paralysis, hemiparesis or sensory impairment, partial positive pyramidal tract signs, and ataxia is rare.

Multiple lacunar infarctions caused by the above reasons must be treated accordingly in order to cure the disease. For example, for multiple lacunar infarctions caused by hypertension, one should measure one's blood pressure regularly and take appropriate medications; for multiple lacunar infarctions caused by heart disease, one should check the heart regularly accordingly. So this is true for any disease. Only early detection, early treatment, and the right medicine can effectively treat the disease and restore health as soon as possible.