[Lacunar cerebral lesions and vascular risk factors]

Since their detailed description by Fisher, lacunar strokes are known to have particular clinical presentations, etiologies and prognostic implications. Small artery disease is at the origin of most lacunes and was classically believed to be mainly due to hypertension. Recent studies have shown no differences in the prevalence of hypertension in patients with lacunar infarction compared to patients with non-lacunar infarction. Vascular risk factors may be different in single versus multiple lacunes and in the presence or absence of leukoaraiosis. The association of several risk factors in an individual patient probably also is of major importance for the development of small artery disease. Further studies on the risk factors for lacunes should separate single from multiple lacunes and carefully analyze the different patterns of risk association.