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Lacunar Infarction
Karen L. Salzman, MD; Ulrich Rassner, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Lacunar infarction (LI), lacunar stroke
            • "Lacunes"
          • Definitions

            • Small, deep cerebral infarcts typically located in basal ganglia (BG) and thalamus, pons, or cerebral white matter (WM), ≤ 15 mm in size
            • From Latin word "lacuna," meaning hole
              • Used to describe small focus of encephalomalacia
            • "L'état lacunaire" or "lacunar state" = multifocal BG lacunar infarcts with surrounding gliosis

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Dhamoon MS et al: Long-term disability after lacunar stroke: Secondary prevention of small subcortical strokes. Neurology. ePub, 2015
                                      2. Sandset EC et al: Effects of Blood Pressure-Lowering Treatment in Different Subtypes of Acute Ischemic Stroke. Stroke. ePub, 2015
                                      3. Hart RG et al: Predictors of stroke recurrence in patients with recent lacunar stroke and response to interventions according to risk status: secondary prevention of small subcortical strokes trial. J Stroke Cerebrovasc Dis. 23(4):618-24, 2014
                                      4. Kitagawa K et al: Association between carotid stenosis or lacunar infarction and incident dementia in patients with vascular risk factors. Eur J Neurol. ePub, 2014
                                      5. Palacio S et al: Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study. Stroke. 45(9):2689-94, 2014
                                      6. Staals J et al: Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology. 83(14):1228-34, 2014
                                      7. Poppe AY et al: Normal magnetic resonance perfusion-weighted imaging in lacunar infarcts predicts a low risk of early deterioration. Cerebrovasc Dis. 28(2):151-6, 2009
                                      8. Wardlaw JM et al: Lacunar stroke is associated with diffuse blood-brain barrier dysfunction. Ann Neurol. 65(2):194-202, 2009
                                      9. De Reuck J et al: The classic lacunar syndromes: clinical and neuroimaging correlates. Eur J Neurol. 15(7):681-4, 2008
                                      10. Arboix A et al: Recurrent lacunar infarction following a previous lacunar stroke: a clinical study of 122 patients. J Neurol Neurosurg Psychiatry. 78(12):1392-4, 2007
                                      11. Vermeer SE et al: Silent brain infarcts: a systematic review. Lancet Neurol. 6(7):611-9, 2007
                                      12. Appelros P et al: Lacunar infarcts: functional and cognitive outcomes at five years in relation to MRI findings. Cerebrovasc Dis. 20(1):34-40, 2005
                                      13. Jackson C et al: Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke. 36(4):891-901, 2005
                                      14. Arboix A et al: New concepts in lacunar stroke etiology: the constellation of small-vessel arterial disease. Cerebrovasc Dis. 17 Suppl 1:58-62, 2004
                                      15. Giele JL et al: Silent brain infarcts in patients with manifest vascular disease. Stroke. 35(3):742-6, 2004
                                      16. Lee SH et al: Comparative analysis of the spatial distribution and severity of cerebral microbleeds and old lacunes. J Neurol Neurosurg Psychiatry. 75(3):423-7, 2004
                                      17. Aharon-Peretz J et al: Progression of dementia associated with lacunar infarctions. Dement Geriatr Cogn Disord. 16(2):71-7, 2003
                                      18. O'Sullivan M et al: Frequency of subclinical lacunar infarcts in ischemic leukoaraiosis and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. AJNR Am J Neuroradiol. 24(7):1348-54, 2003
                                      19. Schmahmann JD: Vascular syndromes of the thalamus. Stroke. 34(9):2264-78, 2003
                                      20. Tejada J et al: Does a relationship exist between carotid stenosis and lacunar infarction? Stroke. 34(6):1404-9, 2003
                                      21. Vermeer SE et al: Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 348(13):1215-22, 2003
                                      22. Longstreth WT Jr et al: Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: the Cardiovascular Health Study. Arch Neurol. 55(9):1217-25, 1998
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • Lacunar infarction (LI), lacunar stroke
                                                • "Lacunes"
                                              • Definitions

                                                • Small, deep cerebral infarcts typically located in basal ganglia (BG) and thalamus, pons, or cerebral white matter (WM), ≤ 15 mm in size
                                                • From Latin word "lacuna," meaning hole
                                                  • Used to describe small focus of encephalomalacia
                                                • "L'état lacunaire" or "lacunar state" = multifocal BG lacunar infarcts with surrounding gliosis

                                              IMAGING

                                              • General Features

                                                • CT Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Dhamoon MS et al: Long-term disability after lacunar stroke: Secondary prevention of small subcortical strokes. Neurology. ePub, 2015
                                                                          2. Sandset EC et al: Effects of Blood Pressure-Lowering Treatment in Different Subtypes of Acute Ischemic Stroke. Stroke. ePub, 2015
                                                                          3. Hart RG et al: Predictors of stroke recurrence in patients with recent lacunar stroke and response to interventions according to risk status: secondary prevention of small subcortical strokes trial. J Stroke Cerebrovasc Dis. 23(4):618-24, 2014
                                                                          4. Kitagawa K et al: Association between carotid stenosis or lacunar infarction and incident dementia in patients with vascular risk factors. Eur J Neurol. ePub, 2014
                                                                          5. Palacio S et al: Lacunar strokes in patients with diabetes mellitus: risk factors, infarct location, and prognosis: the secondary prevention of small subcortical strokes study. Stroke. 45(9):2689-94, 2014
                                                                          6. Staals J et al: Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology. 83(14):1228-34, 2014
                                                                          7. Poppe AY et al: Normal magnetic resonance perfusion-weighted imaging in lacunar infarcts predicts a low risk of early deterioration. Cerebrovasc Dis. 28(2):151-6, 2009
                                                                          8. Wardlaw JM et al: Lacunar stroke is associated with diffuse blood-brain barrier dysfunction. Ann Neurol. 65(2):194-202, 2009
                                                                          9. De Reuck J et al: The classic lacunar syndromes: clinical and neuroimaging correlates. Eur J Neurol. 15(7):681-4, 2008
                                                                          10. Arboix A et al: Recurrent lacunar infarction following a previous lacunar stroke: a clinical study of 122 patients. J Neurol Neurosurg Psychiatry. 78(12):1392-4, 2007
                                                                          11. Vermeer SE et al: Silent brain infarcts: a systematic review. Lancet Neurol. 6(7):611-9, 2007
                                                                          12. Appelros P et al: Lacunar infarcts: functional and cognitive outcomes at five years in relation to MRI findings. Cerebrovasc Dis. 20(1):34-40, 2005
                                                                          13. Jackson C et al: Are lacunar strokes really different? A systematic review of differences in risk factor profiles between lacunar and nonlacunar infarcts. Stroke. 36(4):891-901, 2005
                                                                          14. Arboix A et al: New concepts in lacunar stroke etiology: the constellation of small-vessel arterial disease. Cerebrovasc Dis. 17 Suppl 1:58-62, 2004
                                                                          15. Giele JL et al: Silent brain infarcts in patients with manifest vascular disease. Stroke. 35(3):742-6, 2004
                                                                          16. Lee SH et al: Comparative analysis of the spatial distribution and severity of cerebral microbleeds and old lacunes. J Neurol Neurosurg Psychiatry. 75(3):423-7, 2004
                                                                          17. Aharon-Peretz J et al: Progression of dementia associated with lacunar infarctions. Dement Geriatr Cogn Disord. 16(2):71-7, 2003
                                                                          18. O'Sullivan M et al: Frequency of subclinical lacunar infarcts in ischemic leukoaraiosis and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. AJNR Am J Neuroradiol. 24(7):1348-54, 2003
                                                                          19. Schmahmann JD: Vascular syndromes of the thalamus. Stroke. 34(9):2264-78, 2003
                                                                          20. Tejada J et al: Does a relationship exist between carotid stenosis and lacunar infarction? Stroke. 34(6):1404-9, 2003
                                                                          21. Vermeer SE et al: Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 348(13):1215-22, 2003
                                                                          22. Longstreth WT Jr et al: Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: the Cardiovascular Health Study. Arch Neurol. 55(9):1217-25, 1998