From the Research
Yes, a lacunar infarct can cause mouth deviation, particularly when it affects specific areas of the brain that control facial muscles. Lacunar infarcts are small strokes that occur deep within the brain, typically in the basal ganglia, internal capsule, thalamus, or brainstem. When a lacunar infarct occurs in the internal capsule or corona radiata affecting the corticobulbar tract, or directly in the brainstem affecting the facial nerve nucleus, it can result in facial weakness that includes mouth deviation. This typically presents as drooping of one side of the mouth, with the mouth deviating away from the affected side of the brain (toward the non-paralyzed side of the face). The severity of mouth deviation depends on the exact location and size of the infarct.
Causes and Risk Factors
Lacunar infarcts are usually caused by small vessel disease related to chronic hypertension or diabetes, as noted in studies such as 1. The pathogenesis involves the occlusion of small, penetrating cerebral arteries, which can be due to various factors including microatheroma, lipohyalinosis, fibrinoid necrosis, and Charcot-Bouchard aneurysm.
Diagnosis and Treatment
Diagnosis is made with 1.5 Tesla MRI, as mentioned in 1, and the prognosis is generally good. Treatment focuses on managing the underlying conditions with appropriate medications like antihypertensives or antidiabetics, along with antiplatelet therapy such as aspirin 81-325mg daily or clopidogrel 75mg daily for secondary stroke prevention, as recommended in 2. Physical therapy and speech therapy may be recommended if significant facial weakness persists.
Impact on White Matter Tract Integrity
Recent studies, such as 3, have shown that lacunar infarcts may cause disturbances of the white matter structure remote from the primary lesion, which can be related to cognitive outcomes. This highlights the importance of considering the broader impact of lacunar infarcts on brain function and structure.
Clinical Considerations
In clinical practice, the management of lacunar infarcts should prioritize the prevention of further strokes and the rehabilitation of any resulting deficits. This includes careful control of blood pressure and diabetes, cessation of smoking, and the use of antiplatelet agents as appropriate. The potential for mouth deviation and other facial weaknesses should be considered in the assessment and management plan for patients with lacunar infarcts.