What is the most characteristic MRI finding of lacunar strokes?

What is the most characteristic MRI finding of lacunar strokes?

• A. Large territorial cortical infarcts.
• B. Diffuse white matter lesions.
• C. Multiple large hemorrhages.
• D. Small cavitary lesions called lacunes in deep structures such as the internal capsule.

Answer: (D)

Lacunar strokes come from blockage of small penetrating arteries, producing tiny infarcts in deep brain regions. On MRI the telltale sign is small cavitary lesions in deep structures such as the internal capsule, thalamus, putamen, or pons—these are lacunes that reflect prior small-vessel disease. They’re usually small (often under about 15 mm) and can be CSF-like in signal as they scar and cavitate. This pattern distinguishes them from large cortical infarcts (which involve major arteries and the cortex), diffuse white matter changes (more chronic leukoaraiosis), or hemorrhages (which show bleeding and susceptibility on MRI). So the small cavitary lacunes in deep structures are the classic MRI finding.

Lacunar strokes come from blockage of small penetrating arteries, producing tiny infarcts in deep brain regions. On MRI the telltale sign is small cavitary lesions in deep structures such as the internal capsule, thalamus, putamen, or pons—these are lacunes that reflect prior small-vessel disease. They’re usually small (often under about 15 mm) and can be CSF-like in signal as they scar and cavitate. This pattern distinguishes them from large cortical infarcts (which involve major arteries and the cortex), diffuse white matter changes (more chronic leukoaraiosis), or hemorrhages (which show bleeding and susceptibility on MRI). So the small cavitary lacunes in deep structures are the classic MRI finding.