The clinical presentation of lacunar infarcts is variable and depends upon the size of infarct, the site, and the underlying cause.
Miller-Fisher has described several distinct syndromes:
- pure motor hemiplegia - occurs in 60% of cases; due to a lesion in the posterior limb of the internal capsule
- pure hemisensory stroke - occurs in 10% of cases; due to lesion in the thalamus
- dysarthria with facial weakness and contralateral clumsy hand - occurs in 20% of cases; due to lesion in the pons
- ipsilateral ataxia in the arm or leg, accompanied by leg weakness - rare; due to lesion in the pons
- severe dysarthria with facial weakness - rare; due to lesion in the anterior limb of the internal capsule
- dementia, pseudobulbar palsy and shuffling gait - due to multiple lacunar infarcts; may be confused with parkinsonism; more prevalent in patients with uncontrolled hypertension