What are the expected symptoms of a left periventricular white matter and right cerebellar hemisphere lacunar infarction (Lacunar Infarction, also known as Small Vessel Disease)?

From the Guidelines

Symptoms from left periventricular white matter and right cerebellar hemisphere lacunar infarctions would likely include balance problems, coordination difficulties, and possible dizziness due to the cerebellar involvement. The patient might experience unsteady gait, trouble with fine motor movements, and potentially slurred speech. The left periventricular white matter infarction could cause right-sided weakness or sensory changes, memory issues, and cognitive slowing. These symptoms occur because the cerebellum controls coordination and balance, while periventricular white matter contains nerve fibers connecting different brain regions. Lacunar infarctions are small strokes caused by blockage of small penetrating arteries, typically resulting from hypertension or diabetes 1. The specific symptom pattern depends on the exact location and size of the infarctions, with some patients experiencing minimal symptoms while others have more pronounced deficits. Recovery potential varies, with some improvement typically occurring in the weeks to months following the infarction as brain swelling resolves and compensatory mechanisms develop. Some key points to consider include:

• The cerebellar hemisphere is involved in coordination and balance, so symptoms related to these functions are expected 1.
• Periventricular white matter infarctions can cause a variety of symptoms depending on the location and size of the infarct, including weakness, sensory changes, and cognitive issues.
• Lacunar infarctions are often associated with hypertension and diabetes, which are risk factors for small-vessel disease 1.
• The prognosis for patients with lacunar infarctions is generally better than for those with other types of stroke, with lower mortality rates and a higher likelihood of recovery 1.

From the Research

Expected Symptoms

The expected symptoms from eft periventricular white matter and right cerebellar hemisphere lacunar infarction can be understood by analyzing the effects of lacunar infarcts on white matter tract integrity and the spatial relationship between acute lacunar infarction and white matter hyperintensities.

• Lacunar infarcts may cause disturbances of the white matter structure remote from the primary lesion, leading to cognitive deficits 2.
• The severity of white matter disturbances is related to worse cognitive functioning, independent of the size of the lacune 2.
• Lacunar strokes extent influences white matter hyperintensities volume fate, and the location of recent small subcortical infarcts is associated with the spatial distribution of white matter hyperintensities and the pattern of 1-year white matter hyperintensities evolution 3.
• Half of lacunar infarctions are located at the edge of white matter hyperintensities, and both periventricular white matter hyperintensities and deep white matter hyperintensities are predictors for edge-localized infarction 4.

Cognitive and Motor Symptoms

The symptoms can include:

• Cognitive deficits, such as disturbances in memory, executive functioning, and information processing speed 2.
• Motor symptoms, such as weakness, numbness, or clumsiness, depending on the location of the lacunar infarct.
• The right cerebellar hemisphere lacunar infarction may cause symptoms such as ataxia, dysarthria, or dysmetria 3, 4.

Severity of Symptoms

The severity of symptoms can be influenced by:

• The extent and location of the lacunar infarct 3.
• The severity of white matter hyperintensities 5, 6.
• The presence of vascular risk factors, such as hypertension and smoking 3.
• The patient's age and medical history, such as heart disease 5.