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The plurality of subcortical infarction.

The designation of the term "subcortical infarction" has often been equated with the diagnosis of lacunar infarction. This identity is incorrect and misleading. Lacunes were reported by French authors in the 19th and early 20th centuries; they were considered to correspond to small (usually <1 cm diameter) cavities in the deep cerebral hemispheres parenchyma, resulting from three distinct processes: a small area of infarction, a small area of hemorrhage (lacunar hemorrhage), or an increase in perivascular dilatation. In the 1960s, CM. Fisher described clinicopathological studies on lacunes,which emphasized that lacunar infarcts were usually the consequence of single arteriolar vessel occlusions caused by localized obstruction, described as lipohyalinosis, related to long-standing hypertension. He also suggested that some neurological syndromes (pure motor hemiplegia, pure sensory stroke, ataxic hemiparesis, dysarthria-clumsy hand) were likely to be caused by lacunar infarctions. Based on his clinicopathological studies, Fisher proposed that lacunar infarcts should be separated from other types of cerebral infarction. He emphasized the distinction of superficial infarcts resulting from cortical branch occlusion by embolism versus end-arterial disease.