[Lacunar infarcts]

Lacunar infarcts, small deep infarcts resulting from occlusion of a penetrating artery, account for about a quarter of all ischemic strokes. The view of lacunar infarcts as a benign and rather innocent vascular lesion has been modified during the last years. Although the prognosis is more favourable than other subtypes during the first years, probably due to the small lesion size, in a longer perspective there is an excess risk of death, continual occurrence of recurrent stroke, and development of cognitive dysfunction. The risk of recurrent stroke is similar to most other types of stroke, and patients are at increased risk to develop cognitive decline and dementia. Increasing age, vascular risk factors, and high nocturnal blood pressure have significant prognostic implications for almost all outcomes. Lacunar infarcts and ischemic white-matter disease, the two main types of cerebral small-vessel disease, frequently co-exist and have synergistic effects on prognosis and risk of cognitive decline. Antiplatelet therapy and risk factor modification are the cornerstones in secondary prevention after a lacunar infarct.