Is a lacunar infarct a minor stroke?

Written by Shi De Quan
Neurology
Updated on April 06, 2025
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Lacunar stroke is, in a sense, a milder form of stroke. It may not involve complete paralysis of limbs or consciousness disorders. Such cases typically show symptoms of sudden large vessel blockage. However, it results from blockages in many small vessels and manifests in various ways. Additionally, it gradually worsens, displaying an increasing range of symptoms including cognitive impairments, dementia, unstable gait, slurred speech, and dysarthria. These symptoms significantly affect the quality of life, so it can be considered not mild.

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Premonitory symptoms of cerebral infarction recurrence

The symptoms preceding the recurrence of a cerebral infarction mainly involve observing the symptoms presented during the initial incidence of the stroke. In many cases, the recurrent symptoms are very similar to those initially experienced. For example, if dizziness was a symptom during the previous episode, then dizziness could also be a precursor symptom in a recurrence, with similar nature and intensity of dizziness as before. Additionally, if previous symptoms included limb numbness, weakness, or speech impairment, similar signs might precede a recurrence. Clinically, it is imperative to address these issues before an actual recurrence occurs, such as actively pursuing antiplatelet aggregation therapy, lipid-lowering, and stabilizing plaques, and resorting to surgical treatment if necessary, to better reduce the chances of stroke recurrence.

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Can cerebral infarction be cured completely?

Stroke is not a disease that can be completely cured. Instead, the goal of treatment is to prevent further occurrences and developments of stroke, and there is also the potential for some relative improvement later on. This is considered a very good treatment goal. In the case of stroke, it involves the ischemic necrosis of nerve cells. Additionally, nerve cells have a characteristic that once they die, they cannot regenerate. Therefore, in clinical practice, there are no treatments available that can promote the regeneration of nerves. Treatment can only compensate for the functions of the surrounding healthy nerves to take over the functions of the dead nerves. However, this compensatory process is very slow, often taking two to three months to show significant progress. Hence, it is necessary to continue active rehabilitation exercises later to promote the formation of this compensatory mechanism.

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Causes of Cerebral Infarction

The specific causes of cerebral infarction are mostly seen in older patients with several underlying diseases, such as hypertension, diabetes, and hyperlipidemia. Over time, without well-controlled blood pressure, blood sugar, and blood lipids, arteriosclerosis can easily form within the blood vessels, or atherosclerotic plaques can develop. Once the plaque forms, under certain triggers, the unstable detachment of the vascular plaque can occur. The embolus then moves with the blood flow into the brain and lodges in a narrowed part of the vessel, causing local blood supply areas to experience narrowing or blockage. At this point, a cerebral infarction is likely to form, leading to ischemia, necrosis, and degeneration of the brain tissue supplied by the vessel, resulting in a softening lesion. On a cranial CT scan and MRI, a local low-density shadow can be observed, which is the specific cause of the cerebral infarction.

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How to treat cerebral infarction?

The choice of treatment for cerebral infarction depends on the specific circumstances. Treatment plans for small and large cerebral infarctions are completely different, as are the treatment plans for acute and chronic stages of cerebral infarction. For small areas of acute cerebral infarction, many cases can be treated with intravenous thrombolysis and arterial thrombectomy, which are currently very effective treatments that can significantly help in emergency situations. In the chronic phase, it is necessary to actively improve cerebral circulation, brain protection, lower lipids, stabilize blood sugar, and blood pressure, among other methods, to delay the further progression of the disease. Some cases may also require identifying the cause and opting for surgical interventions, including stent implantation and endarterectomy surgeries.

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Written by Gao Yi Shen
Neurosurgery
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Causes of cerebral infarction

There are many causes of cerebral infarction, but the most common in clinical practice is the narrowing or occlusion of the carotid artery. Since the brain is supplied by four blood vessels, any issues with any of these vessels can potentially lead to a cerebral infarction. Conditions commonly known as the "three highs"—high blood pressure, high blood sugar, and high cholesterol—can easily lead to narrowing or even blockage of the blood vessels. Thus, these factors are fundamentally the cause. Additionally, smoking and drinking can also lead to vascular narrowing and cause cerebral infarction. In some special cases, autoimmune diseases can cause inflammation inside the vessels, leading to narrowing. Other causes include arterial tears due to trauma, which can lead to ischemia and infarction, or abnormal blood supply due to arrhythmias causing cerebral infarction.