What causes lacunar infarctions in stroke?

Updated: Nov 30, 2018
  • Author: Andrew Danziger; Chief Editor: L Gill Naul, MD  more...
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Answer

Lacunar infarctions are small infarcts resulting from occlusion of deep, penetrating end arteries (see the image below). They may be caused by small vessel atherosclerosis and lipohyalinosis related to hypertension or embolic occlusion. Because of the limited area supplied by these perforating end arteries, their obstruction results in a small area of infarction ranging from about 5 mm in diameter up to approximately 15 mm. The most common locations for lacunar infarctions include the basal ganglia, internal capsule, thalamus, and the corona radiata. [16, 17, 18]

Axial noncontrast CT demonstrates a focal area of Axial noncontrast CT demonstrates a focal area of hypodensity in the left posterior limb of the internal capsule in this 60-year-old male with new onset of right-sided weakness. The lesion demonstrates high signal on the FLAIR sequence (middle image) and DWI (right image), with low signal on the ADC maps, indicating an acute lacunar infarction. Lacunar infarcts are typically no more than 1.5 cm in size and can occur in the deep gray matter structures, corona radiata, brainstem, and cerebellum.

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