Answer
Answer
Lacunar infarctions are small, deep cerebral infarctions believed to be caused by intrinsic small-vessel disease secondary to lipohyalinosis and fibrinoid necrosis; they are most frequently observed in patients with hypertension or diabetes mellitus. Common sites for these lesions include the basal ganglia, internal capsule, thalamus, brainstem, and cerebellum. MRI findings in these lesions follow the same pattern observed in thromboembolic infarction.
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Media Gallery
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Magnetic resonance imaging in acute stroke. Left: Diffusion-weighted MRI in acute ischemic stroke performed 35 minutes after symptom onset. Right: Apparent diffusion coefficient (ADC) map obtained from the same patient at the same time.
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Magnetic resonance imaging in acute stroke. Left: Perfusion-weighted MRI of a patient who presented 1 hour after onset of stroke symptoms. Right: Mean transfer time (MTT) map of the same patient.
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Magnetic resonance imaging in acute stroke. Diffusion-perfusion mismatch in acute ischemic stroke. The perfusion abnormality (right) is larger than the diffusion abnormality (left), indicating the ischemic penumbra, which is at risk of infarction.
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The diffusion-weighted MRI reveals a region of hypointensity in the distribution of the right middle cerebral artery. Flanking the anterior and posterior regions of this abnormality are regions of hyperintensities, which represent regions of new infarct. The contiguity of these regions suggests that they are extensions of the old infarct.
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