What is a lacunar infarct? The term “lacunar infarction” is short for lacunar cerebral infarction. It refers to certain ischemic micro-infarcts occurring in the deep part of the brain, and the diameter of the involved cerebral arteries is usually 3~4 mm. It is a special type of cerebral infarction. It is an ischemic necrotic lesion of brain tissue caused by occlusion of microscopic arteries in the deep part of the brain on the basis of hypertension and arterial infarction. Its lesion size is usually 2~15 mm. The diagnosis of this disease is mainly CT or magnetic resonance imaging (MRI) examination, more precisely, it should be MRI, because CT can be false positive (i.e. there are abnormal manifestations that are not luminal infarcts) or false negative (i.e. there are luminal infarcts, but they are not visible). Yang Jingzhen, Medical Imaging Center, China National Petroleum Center Hospital, says that lacunar infarcts do not always have symptoms and abnormal sensations Some people ask, “I have an MRI that says I have a lacunar infarct, but how come I don’t feel anything? Some patients do have cavernous infarcts, but they may not have any symptoms. The reason for this is that the lesion may be located in an unimportant or unaffected area, called a “dummy area”; or the current lesion may be an old infarct (i.e., an old lesion left over from an original infarct); or, although the image is diagnostic of an infarct, the actual lesion itself may look like an infarct or be mistaken for an infarct, but is not a true infarct (see The lesion itself appears to be a luminal infarct or is mistaken for one, but is not a true luminal infarct (see below). ”Myth 1: Mistaking a “perivascular space” for a luminal infarct. In practice, we find this phenomenon in CT or MRI findings or in the recognition of lacunar infarcts by some clinicians. The perivascular space, or Virchow-Robin space (VRS), is a normal anatomical structure of the nervous system with certain physiological and immunological functions. In normal individuals, the white matter of the brain can also show many fine pinhole-like changes, often containing open blood vessels, called the sieve state. The VRS may be increased and enlarged in the elderly or in some pathological states such as atherosclerosis or certain other diseases. For example, a widened VRS can be one of the imaging hallmarks of cerebral small vessel disease. A few younger individuals also have a larger VRS, which may be a congenital variant. Because VRS also occurs in the deep brain, it can be mistaken for luminal infarction. VRS does not require treatment and will not go away. Myth #2: A punctate demyelinating lesion in the white matter of the brain is mistaken for a cavernous infarct. There are many reasons, such as infection, poisoning, ischemia, metabolism, etc., which can cause the loss of myelin sheath of nerve fibers (like the plastic skin of electric wire), called demyelinating lesions (also called cerebral white matter degeneration in mild cases, seen in the elderly), and when such lesions are dotted, it is easy to take them as luminal infarction. Myth 3: Mistaking foci of axonal injury caused by trauma for luminal infarction. When such foci of injury are punctate, they are not easily distinguished from luminal infarcts, and of course, the patient’s history of trauma is important in confirming the diagnosis. However, traumatic cerebral infarction can occur during traumatic brain injury, and some of these foci of infarction occur deep in the brain and are small, which is called traumatic lacunar infarction, and the cause of this traumatic lacunar infarction is different, although the imaging presentation is the same as the lacunar infarction described above. Which test can confirm lacunar infarction or detect earlier lacunar infarction? 1, CT is not the best method (it can be artifactual, see above), MRI is reliable, it can determine the number of luminal infarcts, fresh or old (fresh ones need treatment), especially luminal infarcts occurring in the brainstem, which cannot be diagnosed by CT. 2, MRI examination can distinguish between the three misconceptions mentioned above, but of course the experience of looking at the film is important. 3, MRI uses diffusion-weighted imaging, or DWI for short (a special but commonly used examination method), which can detect super-acute luminal infarction (within 6 hours of the appearance of symptoms) in only about 1 minute, which is beneficial to timely treatment. Of course, this is also true for large scale cerebral infarcts. How do you think about “lacunar infarction”? 1. In elderly people, a small number of lacunar infarct lesions in the brain without symptoms are relatively common and belong to one of the age-related brain changes, so there is no need to worry about them and they do not need to receive treatment. For diabetic patients should pay attention to the control of blood sugar and be alert to the complications of cerebrovascular lesions due to diabetes. Therefore, if there are symptoms of acute cerebrovascular disease and infarction is suspected, MRI examination is preferred, which must include diffusion-weighted imaging. 3. Some primary care doctors see a luminal infarct in the diagnostic imaging report and do not look at the specific situation or check whether it is a responsible lesion, and certainly do not care whether it is a true luminal infarct or a false luminal infarct – infusion treatment, which actually results in over-medication. 4, fresh luminal infarcts with corresponding symptoms need to receive treatment to avoid aggravation or progression; if many luminal infarct foci in the brain are confirmed, even if they are old, they must need attention, or at least indicate that the microvasculature of the brain is very bad.