Lacunar infarction: embolism is the key.

Abstract

Geoffrey A. Donnan MD, FRACP Stephen M. Davis MD, FRACEP Section Editors: Lacunes are small deep infarcts which cavitate, producing “lacunes” (French for lake).1 “Lacunar infarcts” have been thought of as strokes caused by intrinsic disease of small vessels called lipohyalinosis, resulting from hypertension2 and diabetes.3 Contrary to this established dogma, the literature demonstrates that emboli are the cause of lacunes. Almost all of the histopathological evaluation of blood vessels associated with lacunes has been done by C. Miller Fisher. In 11 patients with lacunes there was only a single case of lipohyalinosis compared with 2 cases of cerebral emboli.2 Although not commonly cited this way, Fisher’s own writing demonstrates emboli are more common than lipohyalinosis in patients with lacunes. Fisher was also responsible for the hypothesis of hypertension as a cause of lacunes, based on his report of hypertension in 111/114 of his patients with lacunes. This has not been documented by subsequent studies, which showed hypertension in 24% to 73% of patients …