II. Definitions

  1. Lacune
    1. Small cavity (from latin, "small lake") remaining after a deep brain tissue infarct

III. Pathophysiology

  1. Small infarct size (<1.5 cm)
  2. Occlusions in small, deep, penetrating vessels result in microinfarctions in the distal MCA branches
  3. Small deep penetrating or perforating arteries (Lenticulostriate arteries) arising at head of Middle Cerebral Artery
    1. Lenticulostriate arteries (MCA)
    2. Thalmogeniculate arteries (PCA)
    3. Paramedian perforators (Basilar Artery)
  4. Regions affected
    1. Basal Ganglia
    2. Corona radiata
    3. Thalamus
    4. Brainstem (e.g. paramedian pons)
    5. Internal Capsule

V. Findings: Signs and Symptoms

  1. Pure motor or sensory deficits (Lacunar Syndrome)

VI. Findings: Patterns following lacunar stroke

  1. Pure Motor Hemiparesis (33-50% of Lacunar Infarcts)
    1. Affects posterior limb of Internal Capsule or corona radiata
    2. Contralateral Hemiparesis of face, arm or leg
    3. No sensory deficit
    4. Dysarthria may also be present
  2. Ataxic Hemiparesis
    1. Affects Internal Capsule, pons or corona radiata
    2. Contralateral Hemiparesis of the face and leg
    3. Ataxia of the contralateral arm and leg
  3. Pure Sensory Stroke
    1. Affects Thalamus or corona radiata
    2. Contralateral hemisensory loss of face, arm, leg
  4. Sensory-Motor Stroke
    1. Affects Thalamus, Internal Capsule or Putamen-capsule-caudate
    2. Ipsilateral sensory and motor loss of the face, arm, leg
  5. Clumsy Hand Dysarthria
    1. Affects pons or Internal Capsule
    2. Dysarthria and Dysphagia
    3. Contralateral arm and hand clumsiness (dysmetria, weakness, dysdiadochokinesis)
    4. Contralateral facial paresis and Tongue weakness

VII. Imaging

  1. CT Head
    1. CT Head, as part of emergent stroke evaluation, often misses Lacunar Infarcts
  2. MRI Brain (preferred)
    1. Typically identifies small Lacunar Infarcts

VIII. Resources

  1. Lacunar Stroke Syndromes (Case Western School of Medicine)
    1. http://casemed.case.edu/clerkships/neurology/NeurLrngObjectives/Lacunar%20Stroke.htm

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Infarction, Lacunar (C0333559)

Definition (MSH) Brain infarction that affects small subcortical vessels due to occlusion of a penetrating artery deep in the brain. It may lead to lacunar stroke.
Concepts Disease or Syndrome (T047)
MSH D059409
SnomedCT 230698000, 81037000
Japanese ラクナ梗塞, ラクナコウソク
Spanish infarto lagunar, Infarto Lacunar, accidente cerebrovascular lacunar, infarto lacunar (trastorno), infarto lacunar, Infarto lacunar, infarto lagunar (anomalía morfológica), infarto lacunar (anomalía morfológica)
English lacunar infarction, lacunar infarction (diagnosis), infarcts lacunar, lacunar infarct, lacunar infarctions, infarction lacunar, Lacunar Infarctions, Infarction, Lacunar, Lacunar Infarction, Lacunar Infarcts, Infarct, Lacunar, Lacunar Infarct, INFARCT LACUNAR, Infarctions, Lacunar, Infarcts, Lacunar, LACI - Lacunar infarction, LI - Lacunar infarction, Lacunar infarct, Lacunar infarction, Lacunar infarct (morphologic abnormality), Lacunar infarction (disorder)
Czech Lakunární infarkty
Hungarian Lacunaris infarctus
French Infarctus lacunaire, Infarctus lacunaires
Portuguese Infarto Lacunar, Enfarte lacunar
Italian Infarto lacunare
German Hirninfarkt, lakunaerer, Hirninfarkt, lakunärer, Lakunaerinfarkt
Norwegian Lakunært infarkt, Lakunært hjerneinfarkt
Dutch lacunair infarct

Ontology: Pure motor lacunar infarction (C0393957)

Concepts Disease or Syndrome (T047)
ICD10 G46.5
SnomedCT 195214006, 230699008
German Rein motorisches lakunaeres Syndrom
Korean 순수 운동성 열공 증후군
English pure motor lacunar syndrome (diagnosis), Pure motor lacunar syndrome, Pure motor lacunar infarction, Pure motor lacunar infarction (disorder), pure motor lacunar; syndrome (manifestation), syndrome; pure motor lacunar (manifestation)
Dutch syndroom; zuiver motorisch lacunair, zuiver motorisch lacunair; syndroom, Zuiver motorisch lacunair syndroom
Spanish infarto lacunar motor puro (trastorno), infarto lacunar motor puro

Ontology: Pure sensory lacunar infarction (C0393958)

Concepts Disease or Syndrome (T047)
ICD10 G46.6
SnomedCT 195215007, 230700009
English Pure sensory lacunar infarct, pure sensory lacunar syndrome (diagnosis), Pure sensory lacunar infarction, Pure sensory lacunar syndrome, Pure sensory lacunar infarction (disorder), pure sensory lacunar; syndrome (manifestation), syndrome; pure sensory lacunar (manifestation)
German Rein sensorisches lakunaeres Syndrom
Korean 순수 감각성 열공 증후군
Dutch syndroom; zuiver sensorisch lacunair, zuiver sensorisch lacunair; syndroom, Zuiver sensorisch lacunair syndroom
Spanish infarto lacunar sensitivo puro (trastorno), infarto lacunar sensitivo puro

Ontology: Pure sensorimotor lacunar infarction (C0393959)

Concepts Disease or Syndrome (T047)
SnomedCT 230701008
English Pure sensorimotr lacun infarct, Pure sensorimotor lacunar infarction, Pure sensorimotor lacunar infarction (disorder)
Spanish infarto lacunar sensoriomotor puro (trastorno), infarto lacunar sensoriomotor puro

Ontology: Lacunar ataxic hemiparesis (C0393960)

Concepts Disease or Syndrome (T047)
SnomedCT 230702001
English lacunar ataxic hemiparesis (diagnosis), Lacunar ataxic hemiparesis, Lacunar ataxic hemiparesis (disorder)
Spanish hemiparesia atáxica lacunar (trastorno), hemiparesia atáxica lacunar

Ontology: Dysarthria-clumsy hand syndrome (C0393961)

Concepts Disease or Syndrome (T047)
SnomedCT 230703006
English Dysarthria-clumsy hand syndr, dysarthria - clumsy hand syndrome, dysarthria - clumsy hand syndrome (diagnosis), stroke - lacunar syndrome dysarthria - clumsy hand, Dysarthria-clumsy hand syndrome, Dysarthria-clumsy hand syndrome (disorder)
Spanish disartria - síndrome de manos torpes (trastorno), disartria - síndrome de manos torpes