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Neurological Service of the Massachusetts General Hospital, Boston, MA.
At least 20 different lacunar syndromes have been described and can be recognized by characteristic clinical features. Almost all occur in patients with hypertension. Small lacunes are usually due to lipohyalinosis, larger ones to atheromatous or embolic occlusion of a penetrating vessel. The concept of the "lacunar state" is examined in the light of recent knowledge with the conclusion that the clinical deficit is primarily related to unrecognized normal pressure hydrocephalus rather than to the presence of a few lacunes. The notion that lacunes occur haphazardly is criticized because the first or only lacune tends to be symptomatic. The incidence of cerebral lacunes has declined since the introduction of antihypertensive therapy, an indication that therapy is effective.
Address correspondence and reprint requests to Dr. Fisher, Neurological Service, Massachusetts General Hospital, Boston, MA 02114.
Supported by a grant from the Freed Foundation, Washington, D.C., G. Milton Shy Lecture, New York Neurological Institute, October 29, 1981.
Accepted for publication December 22, 1981.
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K. Nakamura, Y. Saku, S. Ibayashi, and M. Fujishima Progressive motor deficits in lacunar infarction Neurology, January 1, 1999; 52(1): 29 - 29. [Abstract] [Full Text]
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B. Okuda, K. Kawabata, H. Tachibana, and M. S. MD Cerebral Blood Flow in Pure Dysarthria : Role of Frontal Cortical Hypoperfusion Stroke, January 1, 1999; 30(1): 109 - 113. [Abstract] [Full Text] [PDF]
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M. J. Gorman, R. Dafer, and S. R. Levine Ataxic Hemiparesis : Critical Appraisal of a Lacunar Syndrome Stroke, December 1, 1998; 29(12): 2549 - 2555. [Abstract] [Full Text] [PDF]
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M J E Van Zandvoort, L J Kappelle, A Algra, and E H F De Haan Decreased capacity for mental effort after single supratentorial lacunar infarct may affect performance in everyday life J. Neurol. Neurosurg. Psychiatry, November 1, 1998; 65(5): 697 - 702. [Abstract] [Full Text]
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A. Bitsch, W. Klene, L. Murtada, H. Prange, and P. Rieckmann A Longitudinal Prospective Study of Soluble Adhesion Molecules in Acute Stroke Stroke, October 1, 1998; 29(10): 2129 - 2135. [Abstract] [Full Text] [PDF]
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W. T. Longstreth Jr, C. Bernick, T. A. Manolio, N. Bryan, C. A. Jungreis, T. R. Price, and for the Cardiovascular Health Study Collaborative Lacunar Infarcts Defined by Magnetic Resonance Imaging of 3660 Elderly People: The Cardiovascular Health Study Arch Neurol, September 1, 1998; 55(9): 1217 - 1225. [Abstract] [Full Text] [PDF]
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 J. S. Schindler and J. K. Niparko Imaging Quiz Case 1 Arch Otolaryngol Head Neck Surg, July 1, 1998; 124(7): 814 - 818. [Full Text] [PDF]
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C. Kukla, D. Sander, J. Schwarze, I. Wittich, and J. Klingelhofer Changes of Circadian Blood Pressure Patterns Are Associated With the Occurrence of Lacunar Infarction Arch Neurol, May 1, 1998; 55(5): 683 - 688. [Abstract] [Full Text] [PDF]
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B. S. Greenwald, E. Kramer-Ginsberg, K. R. R. Krishnan, M. Ashtari, C. Auerbach, and M. Patel Neuroanatomic Localization of Magnetic Resonance Imaging Signal Hyperintensities in Geriatric Depression Stroke, March 1, 1998; 29(3): 613 - 617. [Abstract] [Full Text] [PDF]
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C. Yokota, Y. Hasegawa, K. Minematsu, and T. Yamaguchi Effect of Acetazolamide Reactivity and Long-term Outcome in Patients With Major Cerebral Artery Occlusive Diseases Stroke, March 1, 1998; 29(3): 640 - 644. [Abstract] [Full Text] [PDF]
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S. Kazui, K. Minematsu, H. Yamamoto, T. Sawada, and T. Yamaguchi Predisposing Factors to Enlargement of Spontaneous Intracerebral Hematoma Stroke, December 1, 1997; 28(12): 2370 - 2375. [Abstract] [Full Text]
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M Giroud, M Lemesle, G Madinier, T. Billiar, and R Dumas Unilateral lenticular infarcts: radiological and clinical syndromes, aetiology, and prognosis J. Neurol. Neurosurg. Psychiatry, November 1, 1997; 63(5): 611 - 615. [Abstract] [Full Text] [PDF]
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S. Kobayashi, K. Okada, H. Koide, H. Bokura, and S. Yamaguchi Subcortical Silent Brain Infarction as a Risk Factor for Clinical Stroke Stroke, October 1, 1997; 28(10): 1932 - 1939. [Abstract] [Full Text]
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A. Arboix, L. Garcia-Eroles, J. B. Massons, M. Oliveres, and E. Comes Predictive Factors of Early Seizures After Acute Cerebrovascular Disease Stroke, August 1, 1997; 28(8): 1590 - 1594. [Abstract] [Full Text]
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T. L. Strassburger, H.-C. Lee, E. M. Daly, J. Szczepanik, J. S. Krasuski, M. J. Mentis, J. A. Salerno, C. DeCarli, M. B. Schapiro, and G. E. Alexander Interactive Effects of Age and Hypertension on Volumes of Brain Structures Stroke, July 1, 1997; 28(7): 1410 - 1417. [Abstract] [Full Text]
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Y. Mochizuki, M. Oishi, and T. Takasu Cerebral Blood Flow in Single and Multiple Lacunar Infarctions Stroke, July 1, 1997; 28(7): 1458 - 1460. [Abstract] [Full Text]
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P. A. Lyrer, S. Engelter, E. W. Radu, and A. J. Steck Cerebral Infarcts Related to Isolated Middle Cerebral Artery Stenosis Stroke, May 1, 1997; 28(5): 1022 - 1027. [Abstract] [Full Text]
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S. Kataoka, A. Hori, T. Shirakawa, and G. Hirose Paramedian Pontine Infarction : Neurological/Topographical Correlation Stroke, April 1, 1997; 28(4): 809 - 815. [Abstract] [Full Text]
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M. C. Brower, N. Rollins, and E. S. Roach Basal Ganglia and Thalamic Infarction in Children: Cause and Clinical Features Arch Neurol, December 1, 1996; 53(12): 1252 - 1256. [Abstract] [PDF]
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L. D'Olhaberriague, I. Litvan, P. Mitsias, and H. H. Mansbach A Reappraisal of Reliability and Validity Studies in Stroke Stroke, December 1, 1996; 27(12): 2331 - 2336. [Abstract] [Full Text]
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H. S. Abram, L. E. Knepper, V. S. Warty, and M. J. Painter Natural History, Prognosis, and Lipid Abnormalities of Idiopathic Ischemic Childhood Stroke J Child Neurol, July 1, 1996; 11(4): 276 - 282. [Abstract] [PDF]
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J. Bogousslavsky, V. Castillo, E. Kumral, I. Henriques, and G. Van Melle Stroke Subtypes and Hypertension: Primary Hemorrhage vs Infarction, Large- vs Small-Artery Disease Arch Neurol, March 1, 1996; 53(3): 265 - 269. [Abstract] [PDF]
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 M. D. Ezekowitz, K. E. James, S. M. Nazarian, J. Davenport, J. P. Broderick, S. R. Gupta, V. Thadani, M. L. Meyer, and S. L. Bridgers Silent Cerebral Infarction in Patients With Nonrheumatic Atrial Fibrillation Circulation, October 15, 1995; 92(8): 2178 - 2182. [Abstract] [Full Text]
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M. O'Rourke Mechanical Principles in Arterial Disease Hypertension, July 1, 1995; 26(1): 2 - 9. [Full Text]
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J. S. Kim, J. H. Lee, J. H. Im, and M. C. Lee Syndromes of Pontine Base Infarction : A Clinical-Radiological Correlation Study Stroke, June 1, 1995; 26(6): 950 - 955. [Abstract] [Full Text]
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