Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 24-08: Stroke + Key Features Download Section PDF Listen +++ ++ Small lesions (usually < 1.5 cm in diameter) occur in the distribution of Short, penetrating arteries in the basal ganglia Pons Cerebellum Internal capsule Thalamus Deep cerebral white matter (less common) (Table 24–3) Risk factors include poorly controlled hypertension and diabetes mellitus Generally has a good prognosis, with partial or complete resolution often occurring over 4–6 weeks + Clinical Findings Download Section PDF Listen +++ ++ There are several clinical syndromes Contralateral pure motor hemiparesis or pure hemisensory deficit Ipsilateral ataxia with crural paresis Dysarthria with clumsiness of the hand Deficits may progress over 24–36 hours before stabilizing + Diagnosis Download Section PDF Listen +++ ++ Sometimes visible on CT scans as small, punched-out, hypodense areas, but in other patients no abnormality is seen In some instances, patients with a clinical syndrome suggestive of lacunar infarction are found to have a severe hemispheric infarct on CT scanning Diffusion-weighted MRI is sensitive to acute lesions, which later evolve into areas of T2 hyperintensity and eventually into small, punched-out, cerebrospinal fluid–filled spaces + Treatment Download Section PDF Listen +++ ++ Treatment is similar to transient ischemic attack and cerebral infarction Control hypertension or diabetes mellitus Avoid tobacco use Anticoagulation is not indicated Aspirin, 325 mg once daily orally, is of uncertain benefit