Lacunar Stroke Syndromes

While there are over twenty described lacunar syndromes, the four that have been best described will be addressed here. These syndromes have been described with ischemic lacunar infarctions as well as with discrete hemorrhages. y

Pure motor hemiparesis is characterized by a unilateral motor deficit involving the face, the arm, and, to a lesser extent, the leg. There may be a mild dysarthria. There is no associated aphasia, apraxia, or agnosia. In addition, there is no sensory, visual, or higher cortical dysfunction. This syndrome may be secondary to a lacunar infarction in the posterior limb of the internal capsule, corona radiata, basis pontis, cerebral peduncle, or the medullary pyramid. y However, an ischemic cortical lesion may also cause a pure motor hemiparesis. y

Pure sensory stroke (pure hemisensory or paresthetic stroke) is characterized by unilateral numbness, paresthesias, and a hemisensory deficit involving the face, arm, trunk, and leg. Subjective complaints may be out of proportion to objective findings. Lacunae in the ventroposterolateral nucleus of the thalamus may cause this syndrome. However, pure sensory stroke can also be due to ischemic infarctions in the corona radiata or in the parietal cortex. y

Ataxic hemiparesis (homolateral ataxia and crural paresis) is characterized by weakness that is more prominent in the lower extremity in association with ipsilateral arm and leg incoordination. Involvement of the face is uncommon. Dysarthria is usually not present. There may be an extensor plantar response. Lacunae in the posterior limb of the internal capsule, basis pontis, red nucleus, or in the thalamocapsular region can cause this syndrome. y , y

The dysarthria-clumsy hand syndrome is characterized by supranuclear facial weakness, tongue deviation, dysphagia, dysarthria, impaired fine motor control of the hand, and an extensor plantar response. There is no sensory deficit. Lacunae in the basis pontis, at the junction of the upper one third and lower two thirds of the pons, or in the genu of the internal capsule may cause this syndrome. y

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