How would you differentiate between a lacunar stroke and a ruptured Charcod-Bouchard aneuryism?

[Lord_Vader]

My understanding is that both types of strokes involve the deep penetrating vessels (i.e. lenticulostriate vessels) and both are due to HTN associated with hyaline arteriosclerosis. Also, both types of strokes result in either pure sensory or motor deficits. So how would you differentiate between the two if you were given a question with both types as possible answer choices?

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[dfib slim]

Lacunar stroke is ischemic, aneurysm is hemorrhagic.

 

[solitarius]

The symptoms are also different.

 

[Radiolucent]

The symptoms are also different.

I´m not sure about that. How would you clinically differentiate between a lacunar infarct in, lets say basal ganglia, and a CB ruptured aneurysm in the same place?

 

[blueshockey]

Lacunar stroke will typically not show up on the initial CT due to their ischemic nature and will show up a week or two later as small "lake-like" lesions, whereas a charcot-bouchard stroke will show up pretty much immediately since it's an intracerebral hemorrhage (vs ischemic stroke).

 

[solitarius]

I´m not sure about that. How would you clinically differentiate between a lacunar infarct in, lets say basal ganglia, and a CB ruptured aneurysm in the same place?

For lacunar infarcts, you will have specific neurological deficits confined to the areas where the gliosis/cysts develop. For the ruptured aneurysms, you will also have to contend with intracerebral hemorrhages and the edema-like symptoms involved.

 

[Radiolucent]

For lacunar infarcts, you will have specific neurological deficits confined to the areas where the gliosis/cysts develop. For the ruptured aneurysms, you will also have to contend with intracerebral hemorrhages and the edema-like symptoms involved.

I´m still not entirely convinced; sure there can be significant associated edema with the bleed but it doesnt always have to be clinically significant to the degree that you can tell them apart.

 

[solitarius]

^ So you're basically saying you need 100% certainty on any info before it's useful? Good luck in your practice.

 

[Radiolucent]

Thats was not my point. Anyway hope the OP got the answer he was looking for.