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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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What are the chances of a recent lacunar infarct being

Customer Question

Customer: What are the chances of a recent lacunar infarct being mistaken or described as a remote infarct?
JA: Thanks. Can you give me any more details about your issue?
Customer: a remote lacunar infarct in the right basal ganglia is reported 2/9/15 after an event 3 days before that resulted in an auto accident. This infarct has been dismissed as non-contributory
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Customer: yes
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Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hello. Welcome to JA. I will review your statement and reply shortly. Please read this preliminary answer and respond if you have questions. Dr Frank

Expert:  Dr. Frank replied 1 year ago.

Hi. Was the lacunar infarction noted on the CT scan of the Brain or an MRI. Where in the right basal ganglia? do you know (putamen, globus pallidus, or caudate nuclei) Let me know and I will try to give you an answer. If you have the full imaging report, please paste it in minus the identifying information (name, etc) as this is a public forum and I will probably be able to give you a more definitive answer. Dr frank

Expert:  Dr. Frank replied 1 year ago.

Since I see you are not here to respond, I will try to send you some information that you can use, please get back to me later, I am on the east coast (NYC) so will be back in the morning. Depending on the location in the basal ganglion, you can or may not have any symptoms from a lacunar infarction. Lacunes come from microvascular disease. The formation of a compound called lipohyalonsis at the 90 degree bifurcations of small blood vessels off the larger cerebral vessels , they penetrate the basal ganglia from below, and can thrombose causing a microvascular ministroke. The issue is that on CT, this is not seen initially, probably not just 3 days after an event. They take weeks to form because the CT can only see the liquefactive change of brain atrophy around the lacune, and that takes time to develop, at least 3 weeks. On MRI the lacune has a varying morphology, as it initially occurs, the swelling will give it a bright appearance on T1 but as the liquefactive changes occur, it becomes dark, a type of T1 black hole. On T2 FLAIR, just the opposite occurs, and it will become a white hyperintensity if old. So I would suppose that they said it could not correlate to an event like an MVA 3 days earlier for one of these reasons. Please get back to me to discuss this further if I can help, or if satisfied with this answer, please remember to rate my service by clicking on the rating stars as that is how I am compensated for this work. Dr Frank