Small Chronic Lacunar Infarct (MRI, kidney, blood pressure, biopsy)
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I was just wondering if anyone knew what this was exactly. I googled it and it appears to be a very small area in the brain where there was an obstruction of blood flow to some very small blood vessels, leading to permanent damage. Many people can be without any symptoms.
I am asking this question because my mother had a hemorrhagic stroke at almost 70 years-old (she died a few years later). She had a platelet count of 20,000 at the time of the stroke. We were told that low platelets most likely played a role in causing the brain bleed. But the doctors always acted as if that wasn't the "whole story" but never told us why. They just acted as if we can chalk up to severely low platelets with *some* degree of certainty.
All that said, I was going through her medical records that had to do with her brain bleed. It said in the main write-up concerning her stroke that there were no other abnormalities found in her brain except for a "small chronic lacunar infarct" (suggesting possibility of very mild cerebral small blood vessel disease).
My question is this: When did my mother develop this chronic lacunar infarct? It was considered "chronic", so it had to have been at least several months before she had her brain bleed stroke, at minimum, right? She must have had a silent stroke with no symptoms. I'm also wondering if the chronic infarct contributed to her brain bleed stroke, on top of having severely low platelets, thus making things even worse as far as her mental recovery after the big stroke.
I am just curious. I cannot get any answers from doctors anymore. It's been too long, but if anyone knows anything that might help me understand things better, I'd be very grateful.
It is impossible for me to say for sure when your mother developed the chronic lacunar infarct, but it is likely that she had it for several months or even years before her hemorrhagic stroke. Lacunar infarcts are typically caused by small blockages in the arteries that supply blood to the brain. These blockages can be caused by a variety of factors, including high blood pressure, cholesterol, and diabetes.
It is also possible that the chronic lacunar infarct contributed to her hemorrhagic stroke. Lacunar infarcts can weaken the blood vessels in the brain, making them more likely to rupture. Additionally, lacunar infarcts can damage the brain tissue, which can make it more susceptible to bleeding.
However, it is important to note that the chronic lacunar infarct was not the only cause of your mother's hemorrhagic stroke. Her severely low platelet count was also a major factor. Platelets are blood cells that help to form clots and stop bleeding. When platelet levels are low, the blood is less able to clot, which can lead to excessive bleeding.
It is possible that the combination of the chronic lacunar infarct and the low platelet count made your mother more susceptible to a hemorrhagic stroke. However, it is also possible that she would have had a hemorrhagic stroke even without the lacunar infarct.
I understand that you are looking for answers, but it is important to remember that every stroke is different. There is no one-size-fits-all answer to the question of how long it takes for a lacunar infarct to develop or whether it can contribute to a hemorrhagic stroke.
The best way to get answers to your specific questions is to speak to a neurologist. A neurologist is a doctor who specializes in the brain and nervous system. They can review your mother's medical records and answer your questions about her stroke.
It is impossible for me to say for sure when your mother developed the chronic lacunar infarct, but it is likely that she had it for several months or even years before her hemorrhagic stroke. Lacunar infarcts are typically caused by small blockages in the arteries that supply blood to the brain. These blockages can be caused by a variety of factors, including high blood pressure, cholesterol, and diabetes.
It is also possible that the chronic lacunar infarct contributed to her hemorrhagic stroke. Lacunar infarcts can weaken the blood vessels in the brain, making them more likely to rupture. Additionally, lacunar infarcts can damage the brain tissue, which can make it more susceptible to bleeding.
However, it is important to note that the chronic lacunar infarct was not the only cause of your mother's hemorrhagic stroke. Her severely low platelet count was also a major factor. Platelets are blood cells that help to form clots and stop bleeding. When platelet levels are low, the blood is less able to clot, which can lead to excessive bleeding.
It is possible that the combination of the chronic lacunar infarct and the low platelet count made your mother more susceptible to a hemorrhagic stroke. However, it is also possible that she would have had a hemorrhagic stroke even without the lacunar infarct.
I understand that you are looking for answers, but it is important to remember that every stroke is different. There is no one-size-fits-all answer to the question of how long it takes for a lacunar infarct to develop or whether it can contribute to a hemorrhagic stroke.
The best way to get answers to your specific questions is to speak to a neurologist. A neurologist is a doctor who specializes in the brain and nervous system. They can review your mother's medical records and answer your questions about her stroke.
You don't know how much I appreciate your response. You made things so much more clearer for me.
My mother never had diabetes, high blood pressure or high cholesterol. She did have calcifications in her brain and other places in her body. They said that it was normal to have some at her age. I remembering seeing artherosceloris somewhere when they were mentioning calcifications. Again, they told me that was normal to some degree at her age. Maybe these blood vessels were hardened in her brain (where she had the small chronic lacunar infarct), weakening them and making them more suspectible to bleeding, particularly when her platelet count was so low.
Thank you again. You've been most helpful. Excellent!!
Lacunar infarcts are tiny splotches in the brain tissue seen on ct or mri scans. They represent "micro-infarcts" (small strokes) that probably don't give symptoms like paralyis, loss of speech, etc seen with larger strokes. They're usually seen in bunches and it's easy to blame them (without proof) when an older pt shows some gradual, nonspecific deterioration in strength, co-ordination, mentation.
It's good to have normal platelet counts and coagulation factor levels so that when we bleed, it stops quickly. Having low levels don't "make you bleed," they prevent you from clotting quickly when you do bleed.
In your Ma's case, there's two problems- why were her platelets low, and why did she bleed? It's a good guess she bled from the combination of brittle, arteriosclerotic blood vessels + elevated BP (at least temporarily)....Various things can cause low platelet counts-- anything that suppresses the bone marrow, from ca, to liver or kidney disease to diseases of the marrow/blood itself.
...and I commisurate with you about talking to doctors. My 94 y/o mother was recently hospitalized. I left a message with the "message center" (nobody gets to talk directly with the office anymore) for the doc to please call Dr. Lamoto (I'm a reired physician)..and it STILL took them 5 days to return the call, and then it was only the nurse. If professional courtesy is no longer important, there's no hope for a mere patient.
After all... Obummercare will still pay them whether or not the pt likes it.
Lacunar infarcts are tiny splotches in the brain tissue seen on ct or mri scans. They represent "micro-infarcts" (small strokes) that probably don't give symptoms like paralyis, loss of speech, etc seen with larger strokes. They're usually seen in bunches and it's easy to blame them (without proof) when an older pt shows some gradual, nonspecific deterioration in strength, co-ordination, mentation.
It's good to have normal platelet counts and coagulation factor levels so that when we bleed, it stops quickly. Having low levels don't "make you bleed," they prevent you from clotting quickly when you do bleed.
In your Ma's case, there's two problems- why were her platelets low, and why did she bleed? It's a good guess she bled from the combination of brittle, arteriosclerotic blood vessels + elevated BP (at least temporarily)....Various things can cause low platelet counts-- anything that suppresses the bone marrow, from ca, to liver or kidney disease to diseases of the marrow/blood itself.
...and I commisurate with you about talking to doctors. My 94 y/o mother was recently hospitalized. I left a message with the "message center" (nobody gets to talk directly with the office anymore) for the doc to please call Dr. Lamoto (I'm a reired physician)..and it STILL took them 5 days to return the call, and then it was only the nurse. If professional courtesy is no longer important, there's no hope for a mere patient.
After all... Obummercare will still pay them whether or not the pt likes it.
Thank you for your kind response. It was very helpful.
My mother had autoimmune aplastic anemia - that is what caused her low platelets of 20,000. But they told us that usually for bleeds to happen like hers in the brain, platelets would normally need to be under 10,000 to cause a brain bleed like she had. They also mentioned "other factors", but never said about the small chronic lacunar infarct, which I believe now played a role in her hemorrhagic stroke. I also know that she had calcification and mild artherosclerosis.
Her heart and other organs were all considered "unremarkable."
I am trying to go over her medical records, and it's really hard to understand the neurological reports. And reading a bone marrow biopsy is like reading Chinese. lol
She had severe anemia for 2-3 months without treatment (no blood transfusions yet). Could this have led to the small lacunar infarct in her brain, considering she was 70 years-old?
She had severe anemia for 2-3 months without treatment (no blood transfusions yet). Could this have led to the small lacunar infarct in her brain, considering she was 70 years-old?
According to AI:
It is possible that your mother's severe anemia for 2-3 months without treatment could have led to the small lacunar infarct in her brain. Anemia is a condition in which the blood does not have enough healthy red blood cells to carry oxygen to the body's tissues. This can lead to a variety of problems, including fatigue, shortness of breath, and dizziness.
In severe cases, anemia can also damage the organs, including the brain. This is because the brain needs a constant supply of oxygen to function properly. When the blood does not have enough oxygen, the brain cells can be damaged or even die.
Lacunar infarcts are small strokes that occur when the blood supply to a small area of the brain is blocked. This can happen for a variety of reasons, including anemia. When the blood supply is blocked, the brain tissue in that area dies.
However, it is important to note that there is no definitive answer to the question of whether your mother's anemia caused her lacunar infarct. There are many other factors that can contribute to lacunar infarcts, such as high blood pressure, cholesterol, and diabetes.
The best way to get an answer to this question is to speak to a neurologist. A neurologist is a doctor who specializes in the brain and nervous system. They can review your mother's medical records and answer your questions about her stroke.
It is possible that your mother's severe anemia for 2-3 months without treatment could have led to the small lacunar infarct in her brain. Anemia is a condition in which the blood does not have enough healthy red blood cells to carry oxygen to the body's tissues. This can lead to a variety of problems, including fatigue, shortness of breath, and dizziness.
In severe cases, anemia can also damage the organs, including the brain. This is because the brain needs a constant supply of oxygen to function properly. When the blood does not have enough oxygen, the brain cells can be damaged or even die.
Lacunar infarcts are small strokes that occur when the blood supply to a small area of the brain is blocked. This can happen for a variety of reasons, including anemia. When the blood supply is blocked, the brain tissue in that area dies.
However, it is important to note that there is no definitive answer to the question of whether your mother's anemia caused her lacunar infarct. There are many other factors that can contribute to lacunar infarcts, such as high blood pressure, cholesterol, and diabetes.
The best way to get an answer to this question is to speak to a neurologist. A neurologist is a doctor who specializes in the brain and nervous system. They can review your mother's medical records and answer your questions about her stroke.
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I worked 30 years in neuro critical care as an RN. When we're talking lacunar we're generally talking deep brain/mid brain which is highly vascularized with micro blood vessels. They are delicate (friable) structures . The explanation in response #2 was very descriptive of the process of these vessels hemorrhaging ... less pliable due to age is the short of it. Vessels get "stiff" due to athlerosclerotic processes and instead of being able to "give" (stretch out under pressure) we develop high blood pressure AND the vessel walls break easier. Due to the fragile nature of cerebral vessels and the sheer immensity of vascular structure in the brain (20% of all the blood leaving the heart goes to the brain) the chance of a vascular incident to out most needed organ (the brain, arguably) is likely. Your mother burst a vessel due to, as stated above, decaying vessel health and probably increased B/P. No way to know the exact cause or why. Obviously a platelet count of 20K contributed to the bleed being worse.
As far as asymptomatic or even slight symptomatic cerebral vascular event I would put forth we all have them to a degree but when they happen in a sensitive area of structure then we will see symptoms. Also be aware that strokes come in 2 flavors . . . occlusive (blockage) which are most strokes. Hemorrhagic strokes are less likely. Also if there is a blockage (occlusive) tissue/cells that was being fed by that vessel can die and will breakdown and this can include the blood vessels. This can lead to bleeding into the older ischemic (occlusive) injury area thus there will be a combination of processes going on ... both a blockage and a bleeding into the brain. Can be hard to determine which came 1st ... the chicken or the egg. But this could be the very cascade of events that happened with your mom. We can't be reasonably sure unless we autopsy.
As far as getting answers from docs just don't sweat it. Lots of things going on with them but the main is god complex/ego/pride/don't want to guess about stuff they don't really understand. Neurologist won't help too much but a neurosurgeon that took care of her could shed some light ... if you could catch them ... probably won't happen.
Sorry but answers on an internet forum are guesses at best. Understanding the brain is something that even the best neuro docs struggle with.
In my experience big lucunar strokes left permanent deficits and were sometimes fatal. But as with all cerebral vascular accidents size and exact location are everything.
I worked 30 years in neuro critical care as an RN. When we're talking lacunar we're generally talking deep brain/mid brain which is highly vascularized with micro blood vessels. They are delicate (friable) structures . The explanation in response #2 was very descriptive of the process of these vessels hemorrhaging ... less pliable due to age is the short of it. Vessels get "stiff" due to athlerosclerotic processes and instead of being able to "give" (stretch out under pressure) we develop high blood pressure AND the vessel walls break easier. Due to the fragile nature of cerebral vessels and the sheer immensity of vascular structure in the brain (20% of all the blood leaving the heart goes to the brain) the chance of a vascular incident to out most needed organ (the brain, arguably) is likely. Your mother burst a vessel due to, as stated above, decaying vessel health and probably increased B/P. No way to know the exact cause or why. Obviously a platelet count of 20K contributed to the bleed being worse.
As far as asymptomatic or even slight symptomatic cerebral vascular event I would put forth we all have them to a degree but when they happen in a sensitive area of structure then we will see symptoms. Also be aware that strokes come in 2 flavors . . . occlusive (blockage) which are most strokes. Hemorrhagic strokes are less likely. Also if there is a blockage (occlusive) tissue/cells that was being fed by that vessel can die and will breakdown and this can include the blood vessels. This can lead to bleeding into the older ischemic (occlusive) injury area thus there will be a combination of processes going on ... both a blockage and a bleeding into the brain. Can be hard to determine which came 1st ... the chicken or the egg. But this could be the very cascade of events that happened with your mom. We can't be reasonably sure unless we autopsy.
As far as getting answers from docs just don't sweat it. Lots of things going on with them but the main is god complex/ego/pride/don't want to guess about stuff they don't really understand. Neurologist won't help too much but a neurosurgeon that took care of her could shed some light ... if you could catch them ... probably won't happen.
Sorry but answers on an internet forum are guesses at best. Understanding the brain is something that even the best neuro docs struggle with.
In my experience big lucunar strokes left permanent deficits and were sometimes fatal. But as with all cerebral vascular accidents size and exact location are everything.
Wow! Thank you so much for taking the time to give me such an excellent response. I do understand things a lot better.
We were never told my mother had "one small chronic lucunar infarct on MRI with likely presence of microvascular small vessel ischemic disease." This is stated in her medical records.
I didn't realize that having severely low platelets would not trigger a bleed, but only make it worse should one begin.
I forgot: There was also hemosiderin stain (scar tissue?), or something. That is all that was really said. She had no other cerebral abnormalities, according to all her brain scan reports.
We were only told my mother had a hemorrhagic stroke, and that the rest of her brain was fine. No mention of the "infarct", as I said above. No mention of the presence of "microvascular ischemic disease", even though it's stated in her medical records.
In summary, what I found out was: my mother had a silent ischemic stroke (lucunar infarct) at least several months before she had her brain bleed stroke (aggravated by very low platelets). She had a microbleed caused by weakened blood vessel (calcifications) that was made much more by very low platelets.
Again, thank you so much. You're fantastic!
Last edited by FrancaisDeutsch; 10-21-2023 at 10:28 AM..
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