Objective: This study aimed to investigate the association between autonomic function and the lacunar strokes, along with a review of the literature to elucidate the interplay between the autonomic nervous system and stroke outcomes. Methods: Thirty-two lacunar stroke patients and 28 healthy age matched control subjects were included. Sympathetic Skin Response (SSR) and R-R Interval Variation (RRIV) values were measured. In the both groups, SSR and R-RIV during rest and deep breathing were recorded for the assessment of sympathetic and parasympathetic function, respectively. Results: The present study revealed significant differences in the autonomic function of patients with lacunar stroke compared with those in the control group. For the SSR, the patients showed a much lower amplitude and longer latency, indicating impaired sympathetic activity. Moreover, the R-R interval variability, both at rest and during deep breathing, was altered, suggesting changes in heart rate variability and parasympathetic function. Conclusion: These study results highlight a marked autonomic dysfunction in patients with lacunar stroke, which has significant implications for clinical management and prognosis.