The most common cause of bilateral multiple lacunar cerebral infarction is due to atherosclerotic cerebrovascular disease. Patients are mostly middle-aged and elderly people with risk factors for atherosclerosis, such as hypertension, hyperglycemia, and hyperlipidemia, which lead to atherosclerosis, poor intima, and poor elasticity of the patient’s blood vessels, which can lead to occlusion of small arteries in the penetrating branches, and the patient can develop multiple lacunar cerebral infarcts. For the treatment of multiple lacunar cerebral infarction, the clinical treatment is based on antiplatelet aggregation, together with blood circulation and blood stasis treatment. Bilateral multiple lacunar cerebral infarction can also be seen clinically in some patients due to aortitis and autoimmune vasculitis, which can lead to recurrent ischemic cerebrovascular disease due to immune inflammation of blood vessels, and patients can be given immunosuppressive therapy if necessary.