Dr. Donohue: Brain scans show small strokes, lacunes

Syndicated Columnist
Published Wednesday, January 15, 2003

DEAR DR. DONOHUE: I had a brain scan that showed I suffered a ministroke. My doctor advised that it was nothing to be concerned about and that many people, unbeknownst to them, would have the same finding. I have a new doctor who advised me to have another scan. It shows new "lacunes" in different areas of my brain. Would you please explain this to me? How dangerous are lacunes? -- M.W.

ANSWER: "Lacune" is a word taken from Latin, and it means a small hole. Lacunar strokes come about from occlusion of tiny brain arteries. The small area of brain severed by those arteries dies and shows up on a scan as a tiny defect -- a lacune. A lacunar stroke might produce arm or leg weakness, trouble speaking, peculiar sensations, numbness or a staggering gait. Not all those symptoms are present. Often, a lacunar stroke is a silent affair and produces no symptoms. Almost always, if symptoms do evolve, they disappear as time passes.

Lacunar strokes are not to be taken lightly. They indicate that a person has a threefold greater chance of having a full stroke than do people without any evidence of them.

The most important measure for preventing additional lacunes or a full-blown stroke is strict control of blood pressure. People who have lacunar strokes frequently have high blood pressure.

Consideration of a patient's general health dictates additional treatment. Blood-thinning medicines such as aspirin, ticlopidine or clopidogrel might be prescribed. If the large neck arteries are partially obstructed with a buildup of cholesterol and fat, cleaning out that buildup surgically is another option.

You don't have to feel as though a catastrophe is around the corner. You do have to take steps to keep blood pressure normal and to lower blood cholesterol by observing a low-fat, low-cholesterol diet. Those are steps that everyone ought to take.

DEAR DR. DONOHUE: How do doctors diagnose Parkinson's disease? My mother's hands shake. In all other respects she appears to be quite healthy. Should she see about taking medicine to slow down progression of Parkinson's disease? -- S.K.

ANSWER: Doctors make a diagnosis of Parkinson's disease by carefully examining patients for the typical signs and symptoms of that illness. Shaking hands happens to be one of those signs. The shaking is most apparent when the hands are resting quietly in the lap or on a table. Other symptoms are equally important. Muscles become rigid, and doctors test for that by moving the arms through their full range of motion. The muscles move a bit, temporarily lock, then move a bit more. The moving-locking process occurs throughout the entire range of arm motion. Parkinson patients walk with small, shuffling steps and often bend forward at the waist while walking. Their sense of balance is poor.

Whether early treatment of Parkinson's slows its progression is an unsettled matter. Doctors who believe it does not alter progression outnumber those who believe it does.

This is a time when there is a bounteous supply of medicines that enhance brain concentrations of dopamine, a chemical messenger that becomes depleted in this illness. Furthermore, there are surgical procedures that assist patients for whom medicine does not alleviate symptoms.

Your mother should see her doctor for a diagnosis of her tremor. She does not have to rush to the doctor for a prescription for Parkinson's medications.

DEAR DR. DONOHUE: If I drink the recommended eight glasses of water every day, would I be excreting, diluting or reducing the potency of my medications and supplements? -- R.M.

ANSWER: Drinking water throughout the day does not lessen the potency of your medicines. The body is adept at extracting medicines from your blood and putting them where they are needed.

The golden rule of eight 8-ounce glasses of water a day has been repealed. People do not need that much water. Urine that is pale yellow or clear indicates if you have drunk enough water.

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