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Ask Dr. Muneeb Ali Your Own Question
Dr. Muneeb Ali
Dr. Muneeb Ali, Doctor
Category: Medical
Satisfied Customers: 7452
Experience:  MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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What type of tx for lacunar strokes, I've had 9 incidents.

Customer Question

what type of tx for lacunar strokes
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: I've had 9 incidents. Great memory loss Lipator 20mg qd
JA: Anything else in your medical history you think the doctor should know?
Customer: norvasc 5mg qd clopidogrel 75mg qd
Submitted: 2 months ago.
Category: Medical
Expert:  Dr. Muneeb Ali replied 2 months ago.

Hi,
Welcome to JA and thanks for this question. Im sorry to hear about your symptoms. Now lacunar strokes usually occur because of a source from where the small blood clots travel to the brain OR due to diseased small vessels in the brain. Usually the first step is to determine if the major arteries in the neck, the carotids are occluded or not. In most cases the carotid arteries are blocked and there are small plaques in the arteries. The plaques break down in the neck and travel to the brain causing lacunar strokes. In this case a caritid doppler ultrasound would be diagnostic and if there are recurrent attacks or if the occlusion is greater than 70% in most cases surgery would be needed or a stent would be passed to reduce the incidence of strokes. Secondly the heart has to be looked into for any possible clots which are breaking down and causing the strokes, this would be diagnosed on a echocardiogram and in this case regular blood thinners like xarekto would be started.

Now if the problem is with the small vessels of the brain or is due to vasculitis, inflammation of the vessels, then the cause of the inflammation would have to be determined. In case of vasculitis, steroids may be used in certain types which can prevent further attacks.

Secondly in case of recurrent attacks, you can be started on TWO anti platelet drugs such as aspirin along with the clopidogrel. Also additional causes should be looked into such as homocysteine levels which can cause recurrent stroke but first the carotid doppler and echocardiogram should be done so that further treatment can be decided here.

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