Understanding and Managing Lacunar Stroke: A 58-Year-Old Woman's Recovery Journey
In this article, we explore the case of a 58-year-old woman who experienced recurrent dizziness and was later diagnosed with lacunar stroke. Initially, her symptoms were attributed to fatigue and lack of rest while taking care of her grandchild. However, when the dizziness persisted and worsened, her family decided to seek medical attention. After undergoing comprehensive medical evaluations, she was diagnosed with lacunar infarction, a type of ischemic stroke caused by small vessel disease in the brain. Her treatment plan included a combination of medications to improve cerebral circulation, stabilize brain cells, and manage underlying risk factors. This case highlights the importance of early diagnosis and tailored treatment in managing lacunar stroke effectively.
Key Patient Information
- Age & Gender: Female, 58 years old
- Diagnosis: Lacunar infarction with multiple microbleeds
- Hospital: Shandong Third Provincial Hospital
- Visit Date: May 2022
- Treatment: Medication-based therapy
- Medications Used: Piracetam Soft Capsules, Citicoline Sodium Capsules, Xueshuantong Soft Capsules, Rosuvastatin Calcium Tablets, and Betahistine Mesylate Tablets
- Follow-Up: Outpatient care with a one-month follow-up
- Outcome: Stable condition with no lingering symptoms
Initial Consultation and Symptoms
The patient visited the clinic accompanied by her daughter, complaining of persistent dizziness that had progressively worsened over time. Initially mistaken for fatigue from caregiving, her condition eventually led to balance issues and unsteady gait. During the neurological examination, the finger-to-nose test was positive, indicating signs of ataxia. Muscle strength and tone were within normal limits. Given the severity of her symptoms, a brain MRI was recommended to evaluate cerebral and vascular health. The results revealed lacunar infarction, and susceptibility-weighted imaging (SWI) confirmed multiple microbleeds. These findings led to a diagnosis of small vessel disease with concurrent cerebral microbleeds.
Treatment Approach and Rationale
The patient presented with ongoing dizziness, nausea, and instability, raising concerns about stroke-related complications. MRI findings confirmed lacunar infarction, while SWI highlighted multiple microbleeds. The presence of microbleeds suggested small artery pathology, including hyaline degeneration or occlusion of deep perforating arteries, leading to ischemic brain injury. Due to the increased bleeding risk associated with microbleeds, aspirin therapy was not recommended. Instead, a combination of neuroprotective and circulation-improving medications was prescribed to enhance cerebral blood flow, support nerve function, and prevent further atherosclerotic progression. Betahistine was included to manage vertigo symptoms, and a follow-up call system was established to monitor medication adherence and response.
Progress and Recovery
Lacunar infarction is typically diagnosed through imaging and may present without noticeable symptoms. In this case, the patient's dizziness was linked to chronic cerebral hypoperfusion. Targeted pharmacological therapy was initiated, including betahistine for dizziness, citicoline for nerve support, and xueshuantong for improved circulation. Within 48 hours of starting treatment, the patient reported significant improvement in dizziness. By the third day, her balance had returned, and she could walk steadily. At the one-month follow-up, her blood pressure was stable, and there were no further complaints. Her condition had improved significantly, indicating a positive response to the treatment plan.
Post-Treatment Care and Risk Management
Following a successful recovery, it is crucial to emphasize the importance of long-term monitoring and preventive care. Lacunar infarction and cerebral microbleeds are both manifestations of small vessel disease, with approximately 60% of lacunar stroke cases showing concurrent microbleeds. The use of antiplatelet agents like aspirin is contraindicated in such cases due to the risk of hemorrhage. Patients should regularly monitor blood pressure, glucose levels, and lipid profiles to prevent stroke recurrence. Awareness of warning signs such as dizziness, speech difficulties, motor impairments, and memory issues is essential for timely medical intervention. Additionally, patients should watch for signs of subcutaneous bleeding during medication therapy and undergo regular blood tests to assess coagulation and overall blood health. Adopting a healthy lifestyle—including a balanced diet, regular exercise, and avoiding smoking and excessive alcohol consumption—is vital for long-term brain and cardiovascular health.
Clinical Insights and Preventive Awareness
Lacunar infarcts can be asymptomatic and may not require aggressive treatment if located outside critical brain regions. However, when symptoms like dizziness and gait instability occur, further investigation is necessary to rule out other cerebrovascular pathologies. In this case, the presence of microbleeds complicated the treatment approach, highlighting the need for careful assessment and individualized care. Early recognition of symptoms, prompt diagnosis, and appropriate management are key to preventing more severe outcomes like major stroke. For patients presenting with symptomatic lacunar infarction, a comprehensive evaluation for underlying vascular conditions—including microbleeds and atherosclerosis—is essential to avoid missed diagnoses and ensure optimal patient outcomes.