ENFOQUE CLINICO, DE DIAGNOSTICO Y TRATAMIENTO DE LOS INFARTOS LACUNARES





ENFOQUE CLINICO, DE DIAGNOSTICO Y TRATAMIENTO DE LOS INFARTOS LACUNARES

(especial para SIIC © Derechos reservados)
Los infartos lacunares representan el 15% a 20% de los infartos cerebrales. Pueden ser silentes clínicamente, ocasionar un ataque isquémico transitorio o bien provocar alguno de los síndromes lacunares clásicos descritos por Miller Fisher. El deterioro cognitivo vascular de tipo subcortical es una complicación grave que puede presentarse a mediano plazo.
arboixdamunt9.jpg Autor:
Adria Arboix
Columnista Experto de SIIC

Institución:
Capio Hospital Universitari del Sagrat Cor de Barcelona


Artículos publicados por Adria Arboix
Recepción del artículo
6 de Mayo, 2013
Aprobación
7 de Junio, 2013
Primera edición
12 de Julio, 2013
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Los infartos lacunares son infartos de pequeño vaso cerebral y de topografia subcortical secundarios a la oclusión de una arteriola perforante y que clínicamente suelen ocasionar un síndrome lacunar clásico (hemiparesia motora pura, síndrome sensitivo puro, síndrome sensitivomotor, hemiparesia atáxica, o disartria-mano-torpe), y con menor frecuencia un síndrome lacunar atípico. La hipertensión arterial y la diabetes mellitus son los principales factores de riesgo. Los infartos lacunares presentan un curso clínico paradójico, con un pronóstico favorable a corto plazo, debido a una baja mortalidad y una discapacidad funcional reducida al alta hospitalaria, pero con un elevado riesgo de recurrencia del accidente cerebrovascular, de demencia e inclusive de muerte, a medio y a largo plazo. La progresión asintomática de la enfermedad de pequeño vaso es una característica típica de la enfermedad de pequeño vaso cerebral. Por esta razón, el infarto lacunar debe considerarse como una entidad potencialmente grave en lugar de considerarse un trastorno relativamente benigno, requiriendo de una gestión sanitaria adecuada y de un correcto seguimiento médico. Los fármacos antiplaquetarios, el control cuidadoso de la presión arterial, el uso de estatinas y la modificación de los factores de riesgo vascular cerebral y del estilo de vida son elementos clave en la prevención secundaria del ictus lacunar.

Palabras clave
infartos lacunares, síndromes lacunares, factores de riesgo, hipertensión arterial, hemiparesia motora pura


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Abstract
Lacunar infarcts (small subcortical infarcts) result from occlusion of a single penetrating artery and account for one fourth of cerebral infarctions. Patients with lacunar infarct usually present: pure motor hemiparesis, pure sensory syndrome, sensorimotor stroke, ataxic hemiparesis, or dysarthria-clumsy hand, and less frequently, an atypical lacunar syndrome. Hypertension and diabetes mellitus are major risk factors for lacunar infarcts. Lacunar infarcts show a paradoxical clinical course with a favorable prognosis in the short term, characterized by a low in-hospital mortality and reduced functional disability on hospital discharge, but with an increased risk of death, stroke recurrence and dementia in the mid and long term. Asymptomatic progression of the small vessel disease is a typical feature of the disease. For this reason, lacunar infarction should be regarded as a potentially severe condition rather than a relatively benign disorder and, therefore, lacunar stroke patients require adequate and rigorous management and follow-up. Antiplatelet drugs, careful blood pressure control, statins and modification of lifestyle risk factors are key elements in secondary prevention after lacunar stroke.

Key words
lacunar infarct, lacunar syndromes, risk factors, arterial hypertension, pure motor stroke


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Geriatría, Neurología
Relacionadas: Anatomía Patológica, Epidemiología, Medicina Interna, Neurocirugía, Salud Mental



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Enviar correspondencia a:
Adrià Arboix, División de Enfermedades Vasculares Cerebrales, Servicio de Neurología , Hospital Universitari del Sagrat Cor, Universitat de Barcelona. , E-08029, Barcelona, España
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