Concept Lacunar cerebral infarction is named after the pathological diagnosis and is a general term for small fresh or old deep cerebral infarcts below 15 to 20 mm in diameter. The occlusion of these small arteries can cause multiple foci of cerebral softening of different sizes, eventually forming large and small lacunae. Depending on the infarcted vessels, different neurological symptoms are often manifested. The most common ones clinically are headache, dizziness, insomnia, amnesia, numbness of limbs, movement disorders, dysphonia – dumb hand syndrome, and in severe cases, dementia, hemiparesis, aphasia, etc. Etiology Deep cerebral penetrating artery occlusion causes the following changes in cerebral arteries in this disease: (a) Fibrinoid changes: seen in severe hypertension, vessel wall thickening, hyperdilatation of small arteries in a segmental fashion, blood-brain barrier disruption, and plasma exudation. (b) Fatty glassy changes: Mostly seen in patients with chronic non-malignant hypertension, penetrating arteries less than 200 μm in diameter, and arterial fatty degeneration can be found in luminal lesions. (iii) Small arterial atherosclerosis: seen in chronic hypertensive patients with vessels 100-400 μm in diameter with typical atheromatous arterial stenosis and occlusion. (iv) Microaneurysm: commonly seen in patients with chronic hypertension. Clinical typing 1.Pure sensory type: Sensory impairment of one side, lip, mouth or limb, such as: cold sensation, heat sensation, tingling sensation, swelling sensation, tactile allergy and other mild sensory impairment. 2.Pure motor soft hemiparesis and its variants: weakness of one side, upper and lower limbs (mild hemiparesis). 3.Ataxic mild hemiparesis: weakness of one lower limb, unstable walking, may be accompanied by sensory impairment; 4.Dysarthria-hand clumsiness syndrome: central facial weakness, dysarthria, nagging eating, mild swallowing difficulty hand weakness writing clumsiness and other ataxic manifestations; Auxiliary examination The symptoms of lacunar cerebral infarction are very atypical, mostly lacking characteristic localization, and when the lesion is 20 mm in diameter, the clinic may be asymptomatic or symptomatic mild. Because of the clinical difficulties in diagnosis by physical examination alone, imaging is particularly necessary for suspected lacunar infarction, and CT or MRI is the best diagnostic tool. MRI is significantly better than CT for lacunar cerebral infarction, as it can detect smaller lesions earlier and can also show lesions in the brainstem and cerebellum very well. Treatment Treatment is based on the same principles as for ischemic stroke, and secondary prevention of cerebrovascular disease is performed. Therefore, active treatment of comorbidities such as hypertension, diabetes mellitus and hyperlipidemia is the key to prevent and treat this disease. Prognosis The prognosis of this disease is good, most of the symptoms disappear in about 2 weeks, and most of the functions can be fully recovered, but in a few cases where the comorbidities are not well controlled and the infarcts are large and numerous, the outcome is not good or there is a possibility of new infarcts.