My Stroke Was NOT F.A.S.T.

Monday, May 09 2022, 7:38PM

I had a large lacunar stroke in June 2021, a type of ischaemic stroke.

My face did not droop.

My arms could both be raised above my head with no difficulty.

My speech was unaffected, being neither slurred nor confused.

And I did not rush to the hospital or call an ambulance.

Madness, surely!

Although an ischaemic stroke, lacunar strokes are not caused by a clot. Lacunar strokes only occur in the smaller arteries and arterioles in the deep (sub-cortical) part of the brain.

Strokes in this region of the brain mostly occur due to thickening and narrowing of the blood vessels, to the point where blood flow becomes very restricted or the lumen itself closes up. Alternatively, these small arteries descend from larger arteries, and it is possible for a plaque smear (not a clot) to cover the entry point to a smaller artery, therefore blocking blood from entering the small artery.

So, why didn’t I rush to hospital or call an ambulance? Because I have a cerebral small vessel disease called CADASIL (see Strokesaurus), I knew I was having a lacunar stroke (the symptoms I experienced were coming on slowly and not simultaneously) and thrombolysis (clot busting drug or clot retrieval) would be useless and possibly dangerous (increased risk of causing a cerebral bleed in cerebral small vessel diseases).

And, 25% of ischaemic strokes are lacunar.