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Martin M. Brown, MD, MRCP
St George's Hospital Medical School Atkinson Morley's Hospital Copse Hill Wimbledon London SW20 0NE

Paul Butler, MB, MRCP, FRCP; John Waterston, MBBS, FRACP; Michael Swash, MD, FRCP, MRCPath
The Royal London Hospital White Chapel London El 1BB United Kingdom

Arch Neurol. 1991;48(12):1215.

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In Reply.

—We are grateful to Dr Albers for his interesting letter and the opportunity to calculate infarct size in our patients in whom deep infarcts were associated with severe carotid occlusive disease. We were well aware of the criticisms of the lacune hypothesis, some of which our article¹ supports. We were, therefore, careful not to describe the infarcts in our article as lacunes, but, instead, preferred the term small deep infarcts. Nevertheless, six of our 10 patients had infarcts that measured 10 mm or less in maximum diameter, fitting the strictest purely radiological definition of a lacune. The smallest deep infarct measured 3 mm across, while the largest measured 15 x 15 mm. Thus, only four infarcts could have been classified as "giant lacunes." Our results emphasize that small deep infarcts, radiologically typical of lacunes, may have an atypical origin. However, we agree that in some cases certain . . . [Full Text PDF of this Article]

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