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Lacunar infarcts are small lesions (usually < 5 mm in diameter) that occur in the distribution of short penetrating arterioles in the basal ganglia, pons, cerebellum, anterior limb of the internal capsule, and, less commonly, the deep cerebral white matter Lacunar infarcts are associated with poorly controlled hypertension or diabetes and have been found in several clinical syndromes, including contralateral pure motor or pure sensory deficit, ipsilateral ataxia with crural paresis, and dysarthria with clumsiness of the hand The neurologic deficit may progress over 24 36 hours before stabilizing Lacunar infarcts are sometimes visible on CT scans as small, punched-out, hypodense areas, but in other patients no abnormality is seen In some instances, patients with a clinical syndrome suggestive of lacunar infarction are found on CT scanning to have a severe hemispheric infarct Early mortality and risk of stroke recurrence is higher for patients with nonlacunar than lacunar infarcts The prognosis for recovery from the deficit produced by a lacunar infarct is usually good, with partial or complete resolution occurring over the following 4 6 weeks in many instances

Lastilla M Lacunar infarct Clin Exp Hypertens 2006 AprMay;28(3 4):205 15 [PMID: 16833026]

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Sudden onset of characteristic neurologic deficit Patient often has history of hypertension, diabetes mellitus, valvular heart disease, or atherosclerosis Distinctive neurologic signs reflect the region of the brain involved

Thrombotic or embolic occlusion of a major vessel leads to cerebral infarction Causes include the disorders predisposing to transient ischemic attacks (see above) and atherosclerosis of cerebral arteries The resulting deficit depends on the particular vessel involved and the extent of any collateral circulation Cerebral ischemia leads to release of excitatory and other neuropeptides that may augment calcium flux into neurons, thereby leading to cell death and increasing the neurologic deficit

In the United States, stroke remains the third leading cause of death, despite a general decline in the incidence of stroke in the last 30 years The precise reasons for this decline are uncertain, but increased awareness of risk factors (hypertension, diabetes, hyperlipidemia, cigarette smoking, cardiac

Solution to Question 19-9. A Trigger element can contain a storyboard action, but not a Storyboard element directly. The BeginStoryboard element provides that action, and can contain a storyboard. Solution to Question 19-10. The DataContext property allows an element to access a data source.

Onset is usually abrupt, and there may then be very little progression except that due to brain swelling Clinical evaluation should always include examination of the heart and auscultation over the subclavian and carotid vessels to determine whether there are any bruits