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Figure 1. MRI diffusion sequences showing a lacunar infarct in the pons in a patient with pure motor hemiparesis.
(Figure omitted. See article PDF.)
Figure 2. T1-weighted MRI image showing a hyperintense lesion due to a small intracerebral hemorrhage in the internal capsule causing pure motor hemiparesis.
(Figure omitted. See article PDF.)
Figure 3. MRI diffusion sequences showing a lacunar infarct in the thalamus of a patient with pure sensory syndrome.
(Figure omitted. See article PDF.)
Figure 4. Fluid-attenuated inversion recovery MRI showing periventricular leukoaraiosis and in the region surrounding the basal ganglia in a patient with dysarthria-clumsy hand syndrome.
(Figure omitted. See article PDF.)
History
Cerebral infarction of the lacunar type is also known as lacune, which means cavity, hole or a small size. The term lacune was used for the first time as a neuropathological criterion by Déchambre in 1838, being considered synonymous of 'cerebral cavity'. Déchambre described cerebral lacunes as small cavities that can be observed in cerebral specimens resulting from reabsorption of necrotic tissue after a small-sized cerebral infarction.
From its initial description until the end of the last century, there has been a great deal of confusion in the literature regarding the term lacune because it was also used to describe cavitary lesions of l'état cribléand the deep gray matter (Durand-Fardel, 1842), that is, multiple, round lesions of small size found in the white matter of both cerebral hemispheres, which are secondary to perivascular dilatation of the Virchow-Robin spaces, located between the pia mater and the perforating cerebral arteries. The term was also indistinctively used to describe scars of small residual infarcts, scars of old small hemorrhages or porosis due to post-mortem bacterial autolysis.
In 1901, Pierre Marie clearly established the classification and concept of the different cavities in the brain based on a study of 50 cases of capsular infarction, and returned the original meaning to the term lacune: secondary lesion to a cerebral infarction due to obliteration of a blood vessel caused by a local atherosclerotic process [1]. In 1902, Ferrand studied 88 necropsies [2] and reached similar conclusions to those of Pierre Marie. Since then Foix, Thurel, Trelles, Garcin and Lapresle successively reported single clinicopathological cases. However, during the first decades of the 20th Century, cerebral...