Lacunar stroke is small but significant
DEAR DR. DONOHUE: I am a 66-year-old man who thought he was in good shape except for a touch of high blood pressure. About a week ago, I suddenly noticed that my left arm and left leg had gone limp. I had to be careful how I walked, and I couldn't hold on to anything. My wife said the left side of my face looked funny, too. The next day, everything was back to normal. My wife insisted that I see the doctor, and he insisted that I have a brain scan. The report said, "Compatible with a lacunar stroke." What is that? The doctor has me taking aspirin and has changed my blood pressure medicine. How serious is this?
— L.R.
The Latin word "lacuna" is "a small cavity or a hole." A lacunar stroke is one due to occlusion of a tiny brain artery that causes a similarly tiny hole in brain tissue. Blood supply to that part of the brain has been cut off.
Yours is the typical story told by those who have had such a stroke. Up to 60 percent of such patients complain of the sudden onset of arm and leg weakness on one side. The face on that side is weakened, too, and looks odd. People who have this kind of stroke never have trouble expressing themselves, as do people who suffer the more common and larger strokes.
Lacunar strokes don't leaving a lasting deficit. People regain what they lost, and usually do so in quick order.
MRI brain scans shows lacunar strokes clearly. A CT brain scan also can spot them.
Almost always, high blood pressure is involved. Just how high is "a touch of high blood pressure"? You have to take blood pressure control most seriously. Get a home blood pressure kit and take your pressure twice a day. You must take the same preventive steps that people who have had a major stroke take: weight reduction if that applies, limitation of salt, daily exercise within the limits prescribed by your doctor and a diet change to include much more fruits, vegetables and grains and much less meat and fats.
DEAR DR. DONOHUE: I am a female in my 80s and have had one child.
I have hair growing on the small of my back, just above the buttocks in the middle. All these years, a doctor has never explained why this is, and I have been too shy to ask. Can you enlighten me on this?
— Anon.
One possible explanation is spina bifida occulta, a malformation of one or two of the lower backbones.
During fetal development, those bones grow from their sides and form an arch over the spinal cord. In spina bifida occulta, there's a gap at the top of the arch. A sign that this has happened is hair growing on the lower back in the place where you indicate. For most with this defect, no symptoms arise. It causes no trouble to the spine or nerves.
If I am right about this, you're an example of one who hasn't suffered any disturbance from this slight abnormality that has been present all your life. The only way to know for sure is to have an X-ray. I don't recommend you do that.
DEAR DR. DONOHUE: Quite often, I go to bed with my hair up in rollers and fasten them with metal clips. Is this harmful in any way? Could it cause ringing in the ears upon arising from sleep? I'd appreciate your thoughts on the above.
— A.F.
It sounds painful to me. Don't the rollers dig into your scalp? If they don't hurt and they aren't cutting you, I can't see how this does you any harm.
It is not the cause of ringing in your ears.
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