Computed tomography in patients presenting with lacunar syndromes.

Of 312 stroke patients who had a CT scan, 37 had presented clinically with a lacunar syndrome. In 18 of the 37, lacunar sized infarcts were demonstrated on the scan, 13 had normal scans and in 6 large infarcts were found. Of these 6.5 and a pure motor hemiplegia and one a pure sensory stroke. Clinical evidence and angiography revealed a potential and treatable source of emboli in both the lacunar sized and the large infarcts. Two conclusions are drawn: a clinical lacunar syndrome may be associated with large infarct; demonstration of a lacunar infarct on CT scan does not exclude the need for angiography in appropriate cases to discover a possible source of emboli.