Lacunar Stroke (Lacunar Infarct)

What is a lacunar stroke?

A lacunar stroke (lacunar infarct) is a stroke that happens when a blood clot blocks one of the small blood vessels deep in your brain. It’s a type of ischemic stroke.

Healthcare providers use the names “lacunar stroke” and “lacunar infarct” interchangeably to describe the same issue. “Infarction” is the medical term for tissue in your body dying because it’s not getting enough blood flow. A stroke is anything that interrupts blood flow in your brain.

Lacunar strokes are life-threatening medical emergencies and can be fatal. If you think you or someone you’re with is having a stroke, immediately call 911 (or your local emergency services number). The sooner someone is diagnosed and treated, the more likely it is they’ll survive a stroke. Every second counts.

What are lacunar stroke symptoms?

Lacunar strokes share symptoms with other types of ischemic strokes, including:

• Weakness or paralysis on one side of your face and body
• Aphasia (trouble speaking or a complete loss of speech)
• Slurred or garbled speaking (dysarthria)
• Loss of muscle control on one side of your face
• Sudden worsening or loss of any of your senses (including your vision, hearing, smell, taste and touch)
• Blurry vision or double vision (diplopia)
• Loss of coordination or clumsiness (ataxia)
• Dizziness or vertigo
• Nausea and vomiting

What are the warning signs of a lacunar infarct?

Lacunar infarcts can cause lots of different symptoms. To recognize the warning signs of a stroke in yourself or a loved one, remember the acronym BE FAST:

• Balance: Watch for a sudden loss of balance.
• Eyes: Look out for sudden vision loss or changes in one or both eyes.
• Face: Smile. Look for a droop on one or both sides of your face.
• Arms: Raise both arms. If you’re having a stroke, one arm will sag or drop in a way that it usually doesn’t.
• Speech: You might slur your speech or have trouble choosing the right words.
• Time: Time is critical — call for help immediately. If possible, look at your watch, phone or a clock to track when symptoms start. Telling a healthcare provider when symptoms began can help them know which treatment options are best for you.

Transient ischemic attacks

A transient ischemic attack (TIA) — sometimes called a “mini-stroke” or a “near stroke” — is like a stroke, but the effects are temporary. These are often warning signs that a person has a very high risk of having a true stroke soon. A person who has a TIA needs emergency medical care as soon as possible.

What causes lacunar strokes?

Lacunar strokes happen when a blood clotblocks a blood vessel in the deep layers of your brain. These inner sections of your brain include areas that control your senses and movement like the basal ganglia and thalamus.

Lots of health conditions can cause blood clots that lead to a lacunar stroke, including:

• High blood pressure (hypertension)
• High cholesterol (hyperlipidemia)
• Clotting disorders
• COVID-19
• Infections that kill tissue in your body. The dead pieces can break free, get into your bloodstream, travel to your brain and get stuck (this is a major complication of sepsis)

Having high blood pressure is the most serious risk factor for lacunar strokes. Talk to a healthcare provider about managing your blood pressure if you know it’s high. They’ll help you get it to a safe level and keep it there.

Lacunar infarct risk factors

Anyone can experience a lacunar infarct, but some groups have a higher risk, including people who:

• Are older than 65
• Are Black
• Smoke or use other forms of tobacco or nicotine (like vaping)
• Use recreational or non-prescription drugs

Having certain health conditions can increase your risk, including:

• A genetic variation in the NOTCH3 gene
• Atrial fibrillation
• Alcohol use disorder
• Atherosclerosis (hardened arteries)
• Diabetes

How do healthcare providers diagnose lacunar strokes?

A healthcare provider will diagnose a lacunar stroke with a neurological exam, a physical exam and tests. Providers in the emergency room may diagnose it if emergency services transport you to the ER.

Your provider will use some of the following tests to confirm that you’ve had a lacunar infarct:

• Blood tests
• CT scan
• Electroencephalogram (EEG)
• Electrocardiogram (EKG)
• MRI

What are lacunar stroke treatments?

The most important part of treating a lacunar stroke is restoring blood flow to your brain. Healthcare providers will do this as fast as possible to reduce your risk of permanent brain damage and death.

The two most common treatments include:

• Thrombolytic therapy. These are medications that dissolve clots. Providers will usually only use them if it’s been fewer than four hours since you started having stroke symptoms because they can increase your risk of dangerous internal bleeding.
• Mechanical thrombectomy. This is surgery to remove a blood clot. Your surgeon will insert a small, thin tube (a catheter) into a blood vessel somewhere else in your body. Then, they’ll thread the catheter up to the clot in your brain. They’ll either vacuum the clot up in one piece or break it apart and suck up the pieces. Many lacunar strokes affect blood vessels that are too small for thrombectomy. Your provider and surgeon will suggest the best options for your situation.

You may need other treatments, including:

• Blood thinners. Anticoagulant medications thin your blood to prevent it from clotting too easily. Your providers may put you on blood thinners after thrombolytic therapy.
• Blood pressure management. Your providers will give you medications to manage your blood pressure and keep it at a safe level.

Lacunar stroke rehabilitation

Stroke rehab is an important part of treating a lacunar stroke. You’ll need stroke rehab to help you adjust to changes in your brain and body after a stroke. You may need to regain abilities you had before or adjust to new or different disabilities. You might need a combination of:

• Speech therapy to regain or improve your language and speaking abilities and control the muscles that help you talk, breathe, eat and swallow. It’s common to need antiplatelet medications after a lacunar stroke.
• Physical therapy to strengthen your muscles, improve your balance and regain the use of your arms and legs.
• Occupational therapy to help you safely complete your daily tasks, especially chores or activities that need precise body movements.
• Cognitive rehab to help improve your memory, concentration and other mental abilities.

Can you prevent a lacunar stroke?

Maintaining your overall health is the best way to prevent lacunar strokes. Try to:

• Manage your blood pressure, cholesterol and any health conditions you have.
• Eat plenty of healthy foods and maintain a weight that’s healthy for you.
• Quit smoking.
• Get regular physical activity.

Visit a healthcare provider for a checkup every year (or as often as they suggest). Many of the health conditions and issues that can cause lacunar infarcts develop or build up over time. They may not cause symptoms you can feel or notice. Your provider will help you catch and manage any warning signs before they increase your risk of a stroke later on.

What is the life expectancy after lacunar strokes?

Stroke survival rates continue to increase as we develop better, faster ways to treat them. But no one set recovery timeline or outlook is accurate for everyone.

Lacunar strokes (and other types of ischemic strokes) tend to have better survival rates than hemorrhagic strokes. But that doesn’t mean you’re more or less likely to survive than anyone else.

Can you fully recover from a lacunar stroke?

Everyone’s body responds differently to a stroke. What a full recovery looks like for you may be different from other people. It’s possible that you regain full use of your brain and body, but you may have new or different disabilities after a lacunar infarct.

What you can expect depends on a few factors, including:

• Your age
• How quickly the stroke was treated
• Your overall health

Most people take a few months to recover. Your provider will tell you what to expect. They’ll help you set recovery goals and expectations that fit your unique health and situation.

How do I take care of myself after a lacunar stroke?

Recovering and rehabbing after a stroke is hard work. Once you and your provider finalize your treatment plan, follow it as closely as possible. In general, you should:

• Take your medications. This is especially true while you’re taking blood thinners. Reducing the risk of future blood clots is important, and taking your medicine as your provider instructs will help your body heal.
• Go to your rehab and other therapy appointments. Tell your therapists if anything makes you feel unsafe or uncomfortable. Rehab is hard work, but you shouldn’t be in constant pain or discomfort.
• Remember your mental health. Depression and anxiety are extremely common after a stroke. Your emotional health can be just as important as how your physical body is doing. You’re not weak or a quitter for feeling sad or upset. Talk to your provider or a mental health professional if you feel like you need help processing anything during your recovery.

Which foods or drinks should I avoid?

Your provider may suggest you add or remove some foods and drinks to your eating plan. They might suggest tweaks to your routine to help you manage health conditions you have and/or to lower your risk of future blood clots after a lacunar infarct.

Common foods you might need to avoid include:

• Alcohol
• Caffeine
• Foods high in sugar
• Foods that have a lot of salt (sodium)
• Fried foods
• Highly processed foods (like deli meat)

When should I go to the ER?

Call 911 (or your local emergency services number) if you think you’re experiencing stroke symptoms again. Another stroke has an even higher risk of causing severe complications and being fatal. Don’t wait to call for help or go to the emergency room.

People who’ve had a lacunar stroke have an increased risk of other potentially serious complications, including:

• Deep vein thrombosis (DVT)
• Heart attack
• Pneumonia
• Pulmonary embolism
• Seizures

Call emergency services or go to the ER if you think you’re experiencing any symptoms of these complications.

Which questions should I ask my doctor?

• Where in my brain did the lacunar infarct happen?
• Which condition or issue caused it?
• Which medications will I need, and how do I take them?
• How will I need to change my daily routine?