The nature of lacunar and non-lacunar brain infarcts continues to elude investigators busy in piling up data. Article Does all single infarction have lower risk of stroke recurre...
This is not merely an academic exercise. There is much beating about the bush with no data providing clarity. This is another insoluble puzzle having exhausted all technological advances. Perhaps viewpoints and syntheses will emerge and merge in this thread.
The question is: does it matter. It’s a lake of CSF. Its relevance is what exactly?
What was initially known regarding small vessel disease / lacunar infarcts that they are secondary to lipohylinosis .. until another theory emerged stating that they develop on top of microatheroma along the origin of the deep penetrating vessels ..
We conducted a study as well as others one of such studies was a large Austrian study on thrombolysis role on lacunar infarcts and it showed that lacunar stroke patients benefit from thrombolysis as large vessels stroke do ..
concluding that lacunar strokes are etiologically thrombotic this may answer your question.
In contrast to surface vessels infarctions, are lacunes not permanent and nonlateralizing?
Any vessel infarct is not permanent unless not treated properly .. lacunes if symptomatic they are then lateralizing like the presentation of pure motor .. or ataxic hemiparesis and so on .. some are silent and discovered just accidentally these are nonlateralizing and open the question of how come they are present on imaging and still not symptomatic may be causing trivial symptom not noticed by patient or may be in area of the brain that its surroundings took its function through neuroplasticity
If you are sure about symptomatic lacunes, perhaps you will provide some references to support your viewpoint. Vessel infarct?? Who says lacune is a vessel infarct? If there is evidence, please present the same, along with a critical review of circumstantial nature of such evidence. How often are lacunes lateralizing and how often non-lateralizing? Any percentages that you can offer? Whenever neurologists cannot explain anything, they turn to neuroplasticity? Correct me if I am wrong.
Permanence of lacunes--the answer is still awaited.
Thrombolysis for lacunes--please quote reference. Then we shall see.
https://www.ncbi.nlm.nih.gov/m/pubmed/28449276/
This is the austrian study on efficacy of thrombolysis on lacunar as well as non lacunar infarcts
If you are aquinted about the SITS database you may have reached an answer about thrombolysis role in different types of ischemic strokes including lacunar strokes yourself
https://www.sciencedirect.com/science/article/pii/B9780409951653500230
https://www.sciencedirect.com/science/article/pii/B9781416047216500109
https://www.sciencedirect.com/science/article/pii/B978141603206910062X
The previous are comprehensive articles regarding lacunar infarcts their nature whether lipohylinosis or microatheroma as well as their presentations which I previously mentioned two of them ..
To your knowledge 20% of ischemic strokes are lacunar strokes and are symptomatic.
Lastly neuroplasticity is a well known concept by it's two sides positive and negative and many worldwide labs work through neuromodulation and computer brain interface work and have published studies on neuroplasticity .. how do you think a patient with a full evident stroke on imaging along the motor area and was presented by hemiparesis regain motor function unless other portions of the brain took the role of the infarcted area ..
I do not think that u viewed videos of patients who are aphasics yet can speak through what is termed musical intonation therapy through making use of homologous areas along the non dominant hemisphere this is by the way is what is termed functional neuroplasticity as well as structural one.
So as an internal medicine not neurologist please check properly neuroplasticity before accusing neurologist that they relate to it when they do not have answers as the matter of fact we do have answers and kindly also check about stroke and its pathophysiology together with international databases regarding outcome in different types of strokes including the lacunar strokes there you will find the percentages you are searching for
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