SUMMARY Of 312 stroke patients who bad a CT scan, 37 had presented clinically with a lacunar syndrome. In 18 of the 37, lacunar sized infarcts were demonstrated on the scan, 13 had normal scans and in 6 large infarcts were found. Of these 6, 5 had a pure motor hemiplegia and one a pure sensory stroke.Clinical evidence and anglography revealed a potential and treatable source of eraboli in both the lacunar sized and the large infarcts. Two conclusions are drawn: a clinical lacunar syndrome may be associated with a large infarct; demonstration of a lacunar infarct on CT scan does not exdude the need for angiography in appropriate cases to discover a possible source of eraboli.Stroke, Vo! 11, No. 3, 1980 THE DETERMINATION of the anatomical localization and pathology of cerebral infarctions is of more than academic importance. Fisher, 1 Caplan 2 and others have emphasized that patients with lacunes have a good prognosis and should not be submitted to potentially hazardous investigations and needless therapy.The word lacune is a neuropathological term referring to a small area of softening usually situated in the distribution of the basal perforating arteries. Such lesions may, however, occur elsewhere such as, for example, in the brain stem. The pathological features of lacunes have been studied by Fisher who also reviewed the history.1 '' In addition, he has delineated a number of clinical syndromes 4 " 7 which, by subsequent autopsy examination of the brain, he identified with lacunes in specific sites. Thus the term lacunar infarct or lacunar stroke has come into use as a clinical term, the pathological and etiological basis being assumed from the clinical features. These include a specific neurological deficit, the frequent association of arterial hypertension and marked tendency to recovery. The Harvard Stroke Registry project, for example, includes lacunar stroke among the cerebrovascular conditions to be recognized. ' The clinical diagnosis of lacunar stroke could only be confirmed if there were some imaging method which would consistently demonstrate the pathological lesion. Computed tomography (CT) can show the larger lacunes. The value of CT in recognizing the smaller ones is limited and varies with the scanning system. It plays an important part in the diagnostic study of strokes, mainly by excluding other types of pathology and it will reveal most infarcts which are too large or superficial to be termed lacunar.The present study was undertaken to determine the CT scan findings in patients presenting with the clinical syndromes which have been considered to be diagnostic of lacunar infarction. MethodsAmong 312 stroke patients who had been studied by CT scanning at the National Hospital, London, on EMI 1010 or 5005 machines, there were 37 who presented with one of 4 syndromes known to be associated with lacunar infarction. All the patients underwent detailed neurological examination during the acute stage of their stroke and fitted into one of the 4 following groups;1. Pure motor hemiplegia (involvin...

The clinical and angiographic correlations of small deep infarcts seen on computed tomography (CT) scan were studied in 297 consecutive patients. Some of these showed the features described by Fisher as part of the lacunar syndrome. In a large number, a source of emboli from either a cardiac or a carotid source was highly probable; in a smaller number, other vascular diseases were present. The finding of a small deep infarct on CT does not exclude the need for further investigation of a possible embolic source in selected patients.

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Hepatolenticular degeneration (Wilson disease) is suspected by the clinical picture and confirmed by characteristic laboratory demonstration of impaired copper metabolism. Three patients with Wilson disease involving the basal ganglia were shown to have abnormalities on computerized tomography (CT) scan, whereas four other patients without signs of cerebral involvement had normal brain scans. Wilson disease may be added to the long list of diseases to which the EMI scan may make a useful diagnostic contribution.

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