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Lacunar infarct
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Lacunar infarct | Radiology Reference Article | Radiopaedia.org

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Dr Jeremy Jones et al.

Lacunar infarcts are small deep infarcts in the distal distribution of penetrating vessels (lenticulostriate, thalamoperforating, pontine perforating
arteries, recurrent artery of Heubner). They result from occlusion of one of the small penetrating end arteries at the base of the brain and are due to
fibrinoid degeneration.
Clinical presentation
Patients without diagnostic imaging who present with symptoms of a lacunar stroke may be described as suffering from a lacunar stroke
syndrome (LACS), one of five distinct syndromes.
Pathology
They are caused by occlusion of one of the small penetrating end-arteries at the base of the brain, thought to result primarily from in situ
microatheroma formation, or lipohyalinosis 2 ( c.f. cortical infarcts where embolisation of distal thrombus is the primary aetiology).
Pathologically, they are small holes of encephalomalacia and are traversed by a cob-web-like mesh of fibrous strands.
Radiographic features
CT

small discrete foci of hypodensity

3-15 mm in diameter, most commonly 10mm
may enhance in the late acute or early subacute stage
unilateral pontine infarcts have a sharp demarcation at the midline
higher signal intensity than CSF (marginal gliosis)
History and etymology
The term was penned by Charles Miller Fisher, a Canadian neurologist who described "lacunes" (Latin: lake) of empty fluid within the brains of
stroke victims post mortem.
Differential diagnosis

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enlarged Virchow-Robin spaces

neurocysticercosis

Related articles
Stroke and intracranial haemorrhage

stroke and intracranial haemorrhage

ischaemic stroke
general discussions[+]
scoring and classification systems [+]
by region
hemispheric infarcts[+]
lacunar infarct
lacunar stroke syndromes
thalamic infarct[+]
cerebellar infarct
brainstem infarct[+]
by vascular territory[+]
intracranial haemorrhage[+]

References
Synonyms & Alternative Spellings
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System: Central Nervous System

Section: Pathology
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Case 2: left thalamic

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