Aug. 11, 2022
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Penetrating artery disease associated with lacunar strokes can occur due to intima thickening alone without hyalinization of the wall (top left), through occlusion of the penetrating artery ostia (called branch occlusive or atheromatous disease, top middle and top right), or lipohyalinosis of deeper parenchymal arterial branches. In the bottom two examples, the antemortem MRI showed a cavitated infarct in the putaminal or external capsule region with coexisting evidence of diffuse lipohyalinosis. (Contributed by Dr. Hugo J Aparicio.)