Why does MRI shows sequela of lacunar type infarction with gliotic changes?

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Magnetic resonance imaging (MRI) findings are compatible with an ischemic stroke in the brain. The stroke could be related to atherosclerosis and diabetes. HbA1c is high, indicative of diabetes. For this reason, I recommend physiotherapy and take daily baby Aspirin to help prevent a future stroke. It is also necessary performing a Doppler ultrasound of the carotid arteries or a carotid and vertebral artery angio computed tomography (CT) scan. It is also essential to check your blood lipid profile. I hope you will find this answer helpful. I remain at your disposal for any further questions whenever you need.

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It is a small stroke, indicative of small vessel disease, which is typically caused by diabetes and arterial hypertension. So, in my opinion, baby Aspirin is the blood thinner that you need. This blood thinner is different from those used in pulmonary embolism as it is an antiplatelet agent. Regarding tests, I would recommend is

1. Doppler ultrasound of the carotid arteries.

2. A blood lipid profile for dyslipidemia (abnormally elevated cholesterol and fats in the blood).

3. Cardiac ultrasound and a resting electrocardiogram (ECG).

4. An ambulatory 24 to 48 hour ECG monitoring for cardiac arrhythmia.

Regarding GGT (gamma-glutamyl transferase), it is a liver enzyme, which is used to diagnose fatty liver or biliary stones. It is not necessary in your case. D-Dimer is not specific for the brain, and it is not required. In the meantime I would recommend taking a daily baby Aspirin (80 to 100 mg), a Statin in case of dyslipidemia and Piracetam for the balance. I hope you will find this answer helpful.