From the Guidelines
The patient with a remote lacunar infarct in the right globus pallidus region should be managed with a focus on secondary stroke prevention, including antiplatelet therapy, blood pressure control below 130/80 mmHg, and cholesterol management with a statin, as these measures have been shown to reduce the risk of future stroke and cardiovascular events 1. Management of the patient should include:
- Antiplatelet therapy with aspirin 81mg daily or clopidogrel 75mg daily to reduce the risk of future stroke
- Blood pressure control below 130/80 mmHg with appropriate medications, as evidenced by the SPS3 trial which showed a reduction in intracerebral hemorrhage with a systolic blood pressure target of less than 130 mmHg 1
- Cholesterol management with a statin, such as atorvastatin 20-40mg daily, regardless of baseline cholesterol levels, as recommended by the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial 1
- Lifestyle modifications, including:
- Smoking cessation
- Limiting alcohol intake
- Regular physical activity
- A Mediterranean or DASH diet The globus pallidus is part of the basal ganglia and helps regulate movement, so the patient should be monitored for subtle motor symptoms, though many lacunar infarcts in this region may be asymptomatic. Regular follow-up with a neurologist is advised to monitor for any new neurological symptoms and to ensure optimal management of stroke risk factors.
From the Research
Lacunar Infarct in the Right Globus Pallidus Region
- A lacunar infarct is a type of stroke that occurs due to the occlusion of a small penetrating artery, resulting in a small, deep infarct in the brain 2.
- The right globus pallidus region is a common location for lacunar infarcts, which can be caused by various arterial disorders such as microatheroma, lipohyalinosis, fibrinoid necrosis, and Charcot-Bouchard aneurysm 2.
- The diagnosis of lacunar infarct is typically made using 1.5 Tesla MRI, and the prognosis is generally good 2.
Treatment and Prevention
- Aspirin has been shown to reduce the risk of recurrent stroke in patients with lacunar stroke, with a significant reduction in stroke recurrence observed in a multicenter prospective cohort study 3.
- The use of antiplatelet therapy, such as aspirin, is a common approach to preventing ischemic stroke, including lacunar stroke 3, 4.
- However, escalation of antithrombotic treatments beyond standard single antiplatelet agents has not been effective in long-term lacunar stroke prevention efforts, and may increase the risk of intracerebral hemorrhage and systemic bleeding 4.
Clinical Syndromes and Outcomes
- Lacunar infarcts can cause a range of clinical syndromes, including pure motor stroke, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and dysarthria with motor disability of one hand 2.
- The outcome of lacunar infarct can vary depending on the location and size of the infarct, as well as the underlying cause of the stroke 2, 4.