Background

Definition

• Defined as stroke caused by occlusion of small vessels in the brain.
• Infarcts are generally rounded, ovoid, or tubular in shape, and < 20 mm in axial diameter
• Infarcts result in a small cavity, or lacune, which typically ranges from > 3 mm to < 15 mm
• Lacunar infarcts are a sign of intrinsic disease of the small vessel, however they may also be caused by non-small vessel mechanism such as arteriosclerosis of parent large vessel and embolism.
  • arteriolosclerosis, lipohyalinosis, and fibrinoid necrosis refer to diffuse, intrinsic disease of small arterioles and have varying degrees of severity
    • small arterioles defined as vessels with diameter 40-200 mcm
    • disease process thought to result largely from hypertension

Epidemiology

• Prevalence of lacunar stroke is approximately 25% of all ischemic strokes.
• 10-15% of lacunar infarcts are due to embolism.

Risk Factors

• Hypertension
• Diabetes
• Smoking
• Older age
• Heart disease
• Hypercholesterolemia
• Insulinemia