A study of lacunar infarcts based on analysis of the main anatomopathological series in the literature

Introduction. There are few clinico-anatomopathological studies of lacunar infarcts (LI), because of the excellent functional prognosis and unlikelihood of death occurring whilst in hospital. Material and methods. We reviewed the 10 main anatomopathological series of LI in the literature. A personal contribution was made based on analysis of the the LI analyzed in 50 consecutive autopsies of patients with cerebrovascular disease. A descriptive clinico-anatomopathological assessment was done. Cerebrovascular risk factors, associated neurological syndromes and causes of death were analyzed. Results. A total of 1,200 cases were analyzed in the 11 anatomopathological series. We most usual number of LI was between 2 and 5 per brain (6 series). The commonest topographical lesions found, in order of frequency, were: In the lenticular nucleus (9 series), thalamus (4 series) and frontal white matter (4 series). The main risk factor was arterial hypertension (AHT), which occurred in between 58% and 90%. The main clinical findings were: Pseudobulbar syndrome (6 series), pure motor hemiparesia (3 series) and clinically silent ischemia (2 series). The causes of death were mainly non-neurological and due to ischemic cardiopathy, sepsis and pulmonary embolism. Conclusions. LI are usually multiple, and topographically they are found at the level of the basal ganglia. AHT is the main cerebrovascular risk factor. The causes of death are usually non-neurological.