Harvard Heart Letter

What is a lacunar stroke?

Ask the doctor

Q. I just reviewed my motherís medical record and it says she had a lacunar stroke. What is that?

A. Most strokes result from a blockage in a blood vessel supplying the brain. Lacunar strokes, which account for about one-fifth of all strokes, are those that occur in small arteries deep inside the brain. These small vessels are uniquely vulnerable to high blood pressure, which can injure the artery wall and lead to an obstruction. Blood clots that grow inside these arteries (or travel from a larger vessel) can also cause lacunar strokes.

This type of stroke typically damages a small area of brain tissue, creating a cavity called a lacune, which is visible on brain imaging tests. Sometimes, lacunar strokes donít cause any noticeable symptoms. When they do, common ones include weakness in the face, arm, or leg on one side of the body. Like most other strokes, treatment might involve a clot-dissolving drug, which must be given intravenously within a few hours of when symptoms first appear.

Many people with lacunar strokes improve fairly quickly (within hours or days) and more than 90% will recover to some extent within a few months. Lacunar strokes have a better rate of recovery than strokes that involve larger blood vessels. To prevent future strokes, your motherís physician will likely recommend that she take a daily aspirin or other blood-thinning medication. If she has poorly controlled blood pressure, that may also need further treatment.

ó Deepak Bhatt, M.D., M.PH.

Editor in Chief, Harvard Heart Letter

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