Lacunar Stroke
Evaluation and Examination:
Signs of lacunar infarcts develop slowly and are either often purely motor or purely sensory. However, other classifications do exist and include ataxic hemiparesis, dysarthrias/clumsy hand, and mixed sensorimotor stroke.
Pure Motor Strokes: Represents the most common type of lacunar infarct, 33-50%, and is characterized by hemiparesis, weakness on one side of the body (Agranoff, 2011). The lacune is usually in the posterior limb of the internal capsule, which carries the descending corticospinal and corticobulbar tracts, or the basis pontis (Agranoff, 2011). Pure motor strokes often consist of hemiparesis or hemiplegia that typically affects the face, arm and leg equally. However, these regions can be involved to a lesser extent than the other. These individuals may have transient sensory symptoms, but not signs. Dysarthria and dysphagia may also be present. Hyperreflexia and a positive Babinski sign will also be present.
Pure Sensory Stroke: The site of the lacunar infarct is usually in the thalamus (Agranoff, 2011). Symptoms consist of numbness and/or tingling one side of the body. Some patients may also complain of burning or some form of unpleasant sensation. A patient may complain of weakness, however, no sign of weakness if found upon examination.
Ataxic Hemiparesis: Represents the second most common form and features a combination of cerebellar and motor symptoms, including weakness and clumsiness, on the ipsilateral side of the body (Agranoff, 2011). The leg is often more affected then the arm. The onset of symptoms may occur over hours or even days. The most frequent sites of the infarct are in the posterior limb of the internal capsule, basis ponta, and corona radiata (Agranoff, 2011).
Common signs include hemiparesis, hyperreflexia, positive Babinski and cerebellar ataxia on the same side of the body as the lacune. Nystagmus may also be present.
Dysarthria/Clumsy Hand: The infarct is most commonly located at the site of the pons (Agranoff, 2011). The main symptoms are dysathria and clumsiness of the hand, which can be observable through individual's handwriting. May present with unilateral facial weakness and dysarthric speech. Additionally, the tongue may deviate to the side of the facial weakness. A mild, ipsilateral hemiparesis may be seen, howeverm the arm is ataxic. May observe ipsilateral hyperreflexia and a positive Babinski sign.
Mixed Sensorimotor Stroke: The infarct is usually in the thalamus and the adjacent posterior internal capsule (Agranoff, 2011). Patients are noted to have hemiparesis or hemiplegia with ipsilateral sensory impairment. May also observe hyperreflexia and a positive Babinski sign.
Components of Neurological Screen:
- Awareness and consciousness
- Speech, language, and memory function
- Vision and eye movements
- Dermatomes
- Myotomes
- Kinesthesia and proprioception
- Deep tendon reflexes
- Walking and balance