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Mysterious holes in the brain: How do small blood vessel infarctions affect your cognitive abilities?
Small vessel infarction (Lacunar stroke) is the most common type of ischemic stroke and results from the occlusion of small penetrating arteries that supply blood to the deep structures of the brain. Patients with this condition may be described as having small vessel infarction syndrome (LACS) when they have not yet undergone diagnostic imaging.
“The effects of this type of stroke are often insidious, and the damage to a patient’s cognitive abilities may not be noticeable in the early stages.”
Knowledge of the pathology of small vessel infarction comes primarily from C. Miller Fisher's postmortem brain anatomy studies. He observed "cavities" in deep brain structures caused by occlusion of small arteries and linked these phenomena to five classic syndromes. These classic syndromes are still mentioned today, although small vessel infarction is primarily diagnosed based on clinical judgment and radiographic imaging.
Signs and Symptoms
Each of these five classic small vessel syndromes has its own unique symptom complex. These symptoms may come on suddenly, or they may come on gradually or in waves (for example, cyst warning syndrome). Although cortical infarction and intracranial hemorrhage occasionally occur, true cortical symptoms such as aphasia, visuospatial neglect, gaze deviation, and visual field defects are always lacking in small vessel infarcts.
Asymptomatic small vessel infarction
Silent small vessel infarction (SLI) is a silent stroke that usually does not show obvious external symptoms, hence the name "silent". Because stroke is a clinical diagnosis (i.e., defined by clinical symptoms), there is debate as to whether SLI should be considered a stroke, although the pathophysiology is presumed to be the same. Individuals with SLI are often unaware that they have had a stroke. This type of stroke often causes lesions in surrounding brain tissue that can be clearly detected by neuroimaging techniques such as MRI and CT scans.
"The existence of silent stroke means that many people have suffered brain damage without even realizing it."
Research shows that silent strokes, which include asymptomatic small vessel infarctions, are much more common than previously thought, with an estimated incidence of up to 11 million cases in the United States each year. About 10% of these silent strokes are asymptomatic small vessel infarcts. Although it is called "silent," silent small vessel infarction can still cause damage to surrounding brain tissue and affect an individual's mood, personality, and cognitive function.
Pathophysiology
According to Koffler et al., these so-called "cavitary brains" result from the occlusion of a single deep penetrating artery directly from the circle of Willis, cerebral arterioles, and basilar cerebral arteries. Other lesions associated with syringomyelia occur in the deep brain nuclei (e.g., lentiform nucleus in 37%, thalamus in 14%, and caudate nucleus in 10%) and in the pons (16%) or posterior limb of the internal capsule. (10%)".
Treatment and Prognosis
For the treatment of small vessel infarction, tissue plasminogen activator can usually be used within 3 to 4.5 hours of stroke, as long as the patient has no contraindications (such as recent major surgery or cancer with brain metastases). Within 48 hours, high-dose aspirin can be given. Long-term relapse prevention regimens mark the treatment of underlying risk factors such as high blood pressure, diabetes, and smoking.
“About 70% to 80% of patients achieve functional independence after one year, which compares favorably with other stroke types.”
Patients with small vessel infarction fare better in terms of survival than other stroke patients, with a 30-day survival rate of 96% and a one-year survival rate of 87%. Occupational therapy and physiotherapy intervention are crucial during the rehabilitation process, which can improve the range of motion of the affected limb through passive movement. It is worth noting that education of stroke symptoms for patients with small vessel infarction and their families cannot be ignored.
Epidemiology
Small vessel infarcts are estimated to account for approximately 25% of all ischemic strokes, with an annual incidence of approximately 15 per 100,000 people, and are more common in men and African Americans, Mexicans, and Hong Kong Chinese universal.
In the process of understanding how small blood vessel infarction affects the brain and cognitive abilities, we must reflect on a question: whether this seemingly harmless brain damage will one day become a hidden part of your life. Sexual threat?
