Prevalence and risk factors

In most series lacunar infarcts are thought to account for about one-quarter of all ischemic strokes, a proportion similar to cardioembolic stroke and infarcts due to large-vessel atherosclerosis. Patients with lacunar infarcts are on average a few years younger than patients with ischemic stroke in general. This is likely to be indirectly linked to the fact that cardioembolic sources become more prevalent with age and consequently patients with cardiac embolism tend to be older.

Lacunar infarcts are formed on a risk-factor profile that comprises age, gender, hypertension, diabetes, smoking, previous TIA and possibly ischemic heart disease. In particular, hypertension was initially thought to be a prerequisite for the development of small-vessel occlusion. However, later studies have demonstrated that the vascular risk-factor profile is not specific for lacunar infarction, but is largely similar to other stroke types [30]. Lacunar infarcts are also part of the clinical spectrum of cerebral autosomal dominant arteriopathy with subcortical infarcts and leuken-cephalopathy (CADASIL), a genetic disease affecting the small arteries of the brain (see Chapter 9).

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