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Rethinking Lacunar Stroke: Beyond Fisher's Curse Osamu Onodera 1 , Masahiro Uemura 1 , Shoichiro Ando 1 , Hideki Hayashi 1 , Masato Kanazawa 1 1Department of Neurology, Brain Research Institute, Niigata University Keyword: ラクナ梗塞 , リポヒアリノーシス , 細小動脈硬化 , 穿通枝 , 細胞外基質 , lacunar stroke , lipohyalinosis , arteriolosclerosis , perforating artery , extra cellular matrix pp.991-998
Published Date 2021/9/1
DOI https://doi.org/10.11477/mf.1416201876
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Abstract

Lipohyalinosis is an important concept in the independence of lacunar stroke; however, its role has been overemphasized and has led to much confusion in the understanding of lacunar stroke. Classical lipohyalinosis has declined following the widespread availability of antihypertensive therapy, and lacunar stroke secondary to age-related hyaline atherosclerosis is more commonly observed in clinical practice. Clinically diagnosed lacunar stroke is associated with several etiopathogenetic contributors. Excluding cardiogenic embolism, lacunar stroke can be categorized based on the detection of an atheroma. Atheroma imaging is possible in recent years, and strokes that are not associated with an atheroma are shown to present with deep white matter hyperintensity on MRI. Additionally, risk gene analysis has confirmed a group of risk genes associated with the extracellular matrix in lacunar stroke with white matter hyperintensity on MRI. These findings suggest the role of a variety of etiopathogenetic mechanisms underlying lacunar stroke and that lacunar stroke with deep white matter hyperintensity on MRI may be attributable to unique pathogenetic contributors. This group is known to be strongly associated with genetic contributors. Hopefully, lacunar stroke will be diagnosed from this perspective with the development of interventional strategies tailored to the pathogenesis of this condition.


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電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院

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