Lacunar infarction in patients with hypertensive intracerebral hemorrhage

Of 300 patients with computerized tomographic (CT) evidence of acute hypertensive intracerebral hemorrhage, high-resolution CT scans showed cerebral lacunar infarction (lacunes) in only nine cases (3%). The lacunes were seen in putaminal (six cases), thalamic (one case), and occipital (two cases) hematomas. All patients with lacunes and intracerebral hemorrhage had had systemic arterial hypertension for 7 to 14 years, cardiographic evidence of ventricular hypertrophy, chest radiographic evidence of cardiomegaly, and funduscopic evidence of retinopathy. The intracerebral hemorrhages were small, with maximal diameters of the hematomas 9 to 18 mm. All patients had good clinical outcome. In a 3-year follow-up, three patients had symptomatic lacunar infarcts but none had recurrent hemorrhage, whereas six patients had myocardial infarction or congestive heart failure.