Moderate , cerebral small vessel disease with lacunar strokes

Hello - I’m an 81 year old female , married , with 3 adult children and 5 lovely grandchildren . I have had RA since I was 48 but kept teaching until I retired at 60 .

Last summer I started having mild headaches . I was a bit concerned as not a ‘headachey’ person so mentioned them to my doctor during my September review .

She offered an MRI to which I agreed . This finally happened mid January and she called me a fortnight later with the results .

Apparently , I’d had multiple lacunar strokes and was diagnosed with cerebral small vessel disease ( moderate ) . My doctor prescribed clopidogrel and upped my atorvastatin . She also organised a Doppler scan on my carotid arteries . These were fine , for my age , apparently. Also I had a 7 day holter monitor , for which I’m waiting the results .

I assume the lacunar strokes were “silent” as I don’t have any physical symptoms ( other than those from RA ) and I don’t appear to have any problems with memory etc . mental agility . I do have occasional mild headaches which are dealt with by paracetamol .

However , reading my MRI report I can see that my brain has definitely been affected . Any readings around the subject of cSVD are rather depressing and it would appear that all - or most - roads lead to vascular dementia .

Has anyone else had a similar diagnosis and subsequent problems ?
No idea what happens next ?

Hello, I am only 55 , had a hemorrhagic stroke in May then found out I also had cerebral small vessel disease and tiny infarcts. I am most upset at my diagnosis but the nuerologist claims that I am just to the right of the bell curve, that this starts around age 60, and that 100% of 80year old will show csvd. Don’t know if that helps but they get annoyed with me being paranoid about this and say everyone will eventually get it, and to just focus on the modifiable risk factors-ie take aspirin, control BP, keep cholesterol low , etc. My nuerologist will not entertain my fear of this absolutely leading to vascular dementia because he claims that my regimen will combat this. Not super reassuring I know.

Shwmae @Wedi, if you haven’t had any obvious symptoms, than these are likely silent strokes. I am no medical authority, but I am to understand that many people as they age experience silent strokes but due to no symptoms being present, these strokes go undetected. In fact, some medical professionals believe that what was once perceived as symptoms of aging can be put down to silent strokes. What I know of lucunar strokes is that it can lead to cardiovascular issues, maybe something to bring up with your GP? I had a stroke at forty-four, I would like to reach your age :grinning: I think you are spot on with being aware of what is going on, and I guess the best thing to do is balance pleasure with cognitive exercise. Feed the brain, reward the brain.

Thank you , Mahoney , for your reply and best wishes . I’ll keep taking the pills :wink:

Thank you so much for your informative reply , Mbhope . I’m sorry to hear that you too have suffered in this way . I had read that a large number of 80 year olds suffered from ‘silent strokes’ but thought it was more like 1 in 4 . But then the more I read around the subject the more the ‘facts’ change . I’m interested to hear that your neurologist doesn’t think the path to vascular dementia is a given . I must keep reminding myself of that . Hope you’re keeping well .

Thank you Rups for your reply . The only reason that the doctor ordered an MRI was because I mentioned headaches , which I now know can be caused by cSVD , lacunar strokes and other brain mishaps .
. I was completely taken aback by the results as I was feeling fine . I guess the clopidogrel , upping of statins , the 7 day holter test and Doppler of carotid arteries will all lead to discovering how well my cardiovascular system is working .
When I saw the doctor in September I was slightly overweight and pre diabetic . I’ve since changed my diet , lost a stone in weight and thrown away the chocolate ( not that I ate much anyway ) . The only thing I find difficult to address is exercise . I find it difficult to walk too far because of my arthritic ( RA ) feet .
Hope you are keeping well .

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Hello Wedi I am sorry you have to deal with this worry when you were feeling well other than your headaches. I am new to this forum as I had a left corona radiata stroke 3 weeks ago. Not well informed enough to know if this is the same as a lacunar stroke or not maybe somebody could help with that? I have done some reading as well and would agree it is depressing. What I have found apart from the usual protocol blood thinners, cholesterol and blood pressure control are important but also the need to keep stable blood sugars. I was indeed glad to see Mbhope’s response was encouraging given the neuro’s expectation that the regimen will combat the risk. I’m holding onto that and running with it as I feel I need to trust all the research and good doctors to steer us in the right direction. I wish you well for your recovery and everybody else who has responded to Wedi’s post. Your words are invaluable.

Hello flo99 ,
Thanks for your reply . I hadn’t heard of left corona radiata so looked it up and from what I have read it would appear to be a form of lacunar stroke . I hadn’t realised that there were so many different types .
You don’t mention whether your stroke affected you physically or was “silent “ like mine and only discovered when an MRI was done for another reason .
I , too , have done a lot of reading around the subject . I’ve discovered that if you put “” into Google then you get the more scholarly articles rather than the “other” type .
I had access to my MRI report , which was helpful . Obviously, I didn’t understand many of the terms but this is where this particular form of “Google” helped .
It’s early days for both of us but I hope that we can get help from this forum as well as our doctors .
At the moment I’m trying to find out if I’m going to be able to continue driving in the future . ( Obviously , I’m not at the moment .)
I hope you’re getting answers to some of your questions . I fear it’s a long , somewhat tortuous road . Keep well !

Hi @Wedi my stroke affected my right side, my arm and leg were quite weak, I have gained back a good bit of strength but my balance is affected leading me to think I have had other ‘silent’ stroke/s in the past. Thank you for your advice regarding google. Should reduce the amount of unfounded information. I also have my MRI report and like yourself just understand bits of it. When I have review with Neurologist in a months time, I’ll be better prepared to ask questions. When you are told this diagnosis it’s quite scary and sends your mind in a whirl there is so much to think about. I was told I could drive after a month as the Neuro told me I had suffered a mild ischaemic stroke, I know everybody’s circumstances are different but I do hope you will be allowed to drive as it will instil some confidence in the soul. You’re in my thoughts. Best wishes Fiona

Thank you Fiona - good to hear from you again .
Were you referred to a neurologist by your doctor ? So far I have only spoken to my GP . She was the one to whom I mentioned headaches when I had my RA review with her last September , and she was the one who organised my MRI and subsequent Doppler scan of carotid arteries and my 7 day holter monitor . The Doppler showed that my carotids were fine ( for my age :wink: ) but haven’t had results from the holter monitor .
I’m wondering if you have to ask for a neurology appointment or if this is only actioned by your GP . As my stroke didn’t have any physical or apparent cognitive deficits I didn’t attend hospital so I’m not sure where or how any subsequent follow ups will take place .
No one has mentioned driving ( or not ) to me and I don’t want to ask until I am armed with all the relative information .
I hope you continue to improve , thoughts and best wishes . It is indeed a scary time .

Hi @Wedi good to hear from you, I presented to A & E with symptoms, I had a CT scan and admitted to the Stroke Assessment Unit where they carried out an MRI the following day then a CT Angiogram. I was diagnosed with the MRI. So I am automatically under a neurologist due to my admission. My doppler was fine too, which had been done a year ago with a suspected stroke after vision loss. Unless you were admitted the only way to get a neurology appointment is to ask your GP as he is your Primary Care Physician. The hospital being Secondary Care. Your GP is quite on the ball when she organised the scans, that is essentially what your neurologist would have done at initial appointment, so she has got you a little further down the track. Getting an ECG monitor and BP monitor this week and an echo in 2 weeks time. Best wishes.

Thanks so much for your quick reply . Yes I’m really impressed by my GP . She phoned me at about 8:30 pm , as soon as she had received the MRI results , as she wasn’t going to be in the surgery the next day . She also told me to take 4 of my 10mg atorvastatin that night and to collect a prescription of clopidogrel the next day . Then she organised the scans the next day . I decided to go privately as the MRI had taken so long before I was called . At my age I feel I need to get on with things .:blush:
I hope all your investigations are satisfactory and that you can get on with the important job of living . Take care !

Ah @Wedi so good to hear that regarding your GP, she’s looking after you well. Bp monitor tomorrow just concentrating on keeping blood sugars low and being careful what I eat. Listening to Michael Mosley’s podcast ‘Just one thing’ really good just 15 minute bite sized advice for health in general. I find concentrating on stroke focused podcasts just too much at the minute. The brain doesn’t like too much chatter at the minute, what I mean by that is i’m walking every day and getting out in the fresh air, lifts the mood and distracts me. I hope you keep well.

Glad to hear that things are moving for you .I’ll listen to MMs podcast , he usually makes a lot of sense .Good luck with the BP monitor .
Take care !

@Wedi Thank you. Look after yourself. Fiona