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For further information, see CMDT Part 24-09: Stroke
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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
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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
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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