Major lacunar syndromes

Pure motor hemiparesis-- could be capsular, corona radiata, or basis pontis lacune with mild dysarthria. History of prior transient gait abnormality or vertigo favors pontine. Ischemic cortical lesions may also cause this.

Pure sensory-- due to stroke VPL thalamus (pansensory), corona radiata (st sensory), parietal cortex or pontine stroke of medial lemniscus may cause. A pain and temperature deficit due to midbrain stroke of st tract is described. Tract specific deficit of sensory favors lesion away from thalamus.

Ataxic hemiparesis. due to lacune in posterior limb, or pons.LE weakness and hemiataxia is rule. Dysarthria is rare, but a Babinski sign is present. Other localizations are thalamocapsular, red nucleus, superficial aca infarcts.

Dysarthria-clumsy hand syndrome is due to lacune of pons or internal capsule, or small hemorrhages of putamen and genu with micrographia. There is supranuclear facial weakness, deviation of protruded tongue, dysarthria, dysphagia, loss of fine control of hand, and extensor plantar response.