The spectrum of lacunar infarction in the elderly

Lacunar infarcts are small subcortical ischemic brain lesions caused by occlusion of a perforating arteriole. The occlusion results from thickening of the arteriolar wall (arteriolosclerosis), is related to aging, and is accelerated by arterial hypertension. The infarction is usually associated with one of several clinical lacunar syndromes, depending on the exact location of the lesion. Patient evaluation should include the documentation of infarct size and location with imaging studies and the search for uncommon hematologic derangements that predispose to thrombosis. Recovery from a single lacunar infarction is usually very good. Most important in prevention of lacunar infarction recurrence is control of hypertension. Aspirin therapy also appears to be beneficial.