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Lacunar strokes are probably part of the spectrum of small vessel disease (SVD), which affects small arteries, arterioles, venules, and capillaries in the brain, has long been associated with cognitive impairment and dementia. Lacunes are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease
Lacunar strokes are typically subcortical involving white matter tracts and so classically no cognitive loss, aphasia or other higher functions affected. May at times be a staggered slow presentation.
|Pure Motor Stroke (PMS)
|Usually the commonest in clinical practice. Unilateral, pure motor deficit. Clearly involving two of three areas (face, arm and leg) With the whole of any limb being involved. Can be anywhere along the corticospinal tract including the posterior limb of the internal capsule or the basis pontis.
|Pure Sensory Stroke (PSS)
|Unilateral purely sensory symptoms ( +/- signs) Clearly involving two of three areas (face, arm, and leg) With the whole of any limb being involved. Lesion in the brainstem or thalamus (ventral) or thalamocortical projections classically.
|Ataxic Hemiparesis (AH)
|Ipsilateral cerebellar and corticospinal tract signs. With or without dysarthria . No higher cerebral dysfunction or a visual field defect. Lesion can be anterior limb of internal capsule or corona radiata. Others report posterior limb IC, thalamus, lentiform nucleus and cerebellum.
|Sensorimotor Stroke (SMS)
|PMS and PSS combined (i.e., unilateral motor and sensory signs and symptoms) . No higher cerebral dysfunction or a visual field deficit. Lesion in thalamus/internal capsule or corona radiata
|Dysarthria-clumsy hand syndrome
|dysarthria and upper limb ataxia and clumsy hand. Usually a lacune of the anterior limb of the IC. Also, in pontine lesions
|Basilar branch syndromes
|a great number of lacunes cause no symptoms at all and are only found incidentally on imaging. In fact silent are 5 times as common as non-silent.