Abstract
Clinical diagnosis of subcortical infarction, chiefly lacunar stroke, has been considered important for arriving at the most rational stroke diagnosis and treatment strategy. This review focuses on the lacunar hypothesis and potential inaccuracy of clinical diagnosis and computed tomography in subcortical stroke. Modern magnetic resonance imaging techniques have increased sensitivity and specificity for subcortical infarcts and may help in determining the pathogenesis in individual patients. Full investigation is now favored for all stroke patients regardless of the clinical diagnosis. Acute stroke and secondary prevention treatments are discussed in reference to a diagnosis of subcortical infarction.