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Clinical Lacunar Syndrome
Lacunar strokes tend to occur in patients with diabetes, hyperlipidemia, smoking
or chronic hypertension and may be clinically silent or present as pure motor hemiparesis,
pure sensory loss, or a variety of well-defined syndromes (e.g., dysarthria-clumsy
hand, ataxic-hemiparesis). Descending compact white matter tracts or brainstem gray
matter nuclei are injured, often producing widespread and striking initial deficits.
However, the prognosis for recovery with lacunar stroke is better than with large
artery territory stroke, and for this reason many centers favor using antiplatelet
therapy (aspirin, clopidogrel) or conservative management rather than thrombolytic
therapy for uncomplicated lacunar stroke. The risk of hemorrhagic transformation
or edema in these patients is extremely low. Because initial clinical presentation
may be deceiving particularly in the posterior circulation, all patients presenting
with acute ischemic symptoms should undergo some form of neurovascular imaging to
establish large vessel patency (CTA, MRA, ultrasound or angiography).
Additional Diagnostic Testing
Prevention of Acute Recurrent Stroke
Subacute Medical Management
Communicate with PCP
Functional Assessment and Acute Rehabilitation
Communicate with other healthcare personnel
Discuss with patient and family
Assess subacute rehabilitation needs and eligibility (consider PM&R consult)
Assess financial resources to cover cost of
Long term Secondary Prevention
Risk factor modification
Reviewed/Approved by: Drs. Singhal and Rost
Last reviewed: 4/8/2010
Last updated: 4/8/2010
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