When extensive lacunar cerebral infarction is present, it makes a Swiss cheese like presentation in the deeper parts of the brain. The lesion is often referred to as a lacunar state. Its common clinical manifestations are as follows: 1. Pseudomyelopathy with abnormal speech, swallowing and emotional control 2. small gait 3. Parkinsonian-like tonicity 4. hyperreflexia 5. metatarsal reflexes exhibiting tonicity 6. dementia with slowed thinking and response 7. various signs and symptoms of weakness and sensation Recent experience, particularly from CT and MRI, questions this traditional view. First, many patients with lacunar cerebral infarction appear to be physically healthy and functionally normal. Second, patients who exhibit the above symptoms almost always have fairly severe white matter changes and ventricular enlargement.