Tiny Strokes, Big Consequences: Understanding Lacunar Stroke

Lacunar strokes can have major long-term health impacts, even when asymptomatic

Published on Feb. 21, 2026

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Lacunar strokes are a common type of stroke that occur when a blood clot blocks a tiny artery deep in the brain, causing damage in a small area. While some lacunar strokes result in noticeable symptoms like weakness, numbness, or speech issues, many are asymptomatic and go unnoticed. However, even 'silent' lacunar strokes can significantly increase the risk of cognitive decline, dementia, and future strokes. Risk factors include high blood pressure, diabetes, and certain genetic disorders. Prompt diagnosis and treatment, including medications to dissolve clots or prevent new ones, are crucial.

Why it matters

Lacunar strokes are often overlooked, but they can have serious long-term consequences even when they don't produce obvious symptoms. Understanding the risk factors and treatment options for these small but impactful strokes is important for preventing future health issues, especially in older adults.

The details

Lacunar strokes occur when a blood clot blocks a tiny artery deep in the brain, damaging or killing brain cells in an area typically less than 15-20 millimeters. They account for up to 20% of all strokes. Symptomatic lacunar strokes can result in one of five distinct syndromes: pure motor hemiparesis, pure sensory stroke, ataxic hemiparesis, dysarthria/clumsy hand syndrome, or sensorimotor stroke. However, many lacunar strokes are asymptomatic, with studies suggesting up to 20% of seemingly healthy elderly people show evidence of 'silent' lacunar strokes on brain scans.

  • Lacunar strokes often occur in people ages 55 and older, though they can happen at younger ages as well, especially with certain genetic disorders.

The players

Maria Sokola, MD

A neurologist at the Cleveland Clinic who provided expert insights on lacunar strokes for this article.

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What they’re saying

“Time is of the essence with strokes. The sooner treatment is received, the greater the range of available treatment options and the better the odds of recovery.”

— Maria Sokola, MD, Neurologist (bottomlineinc.com)

What’s next

Patients who suspect they or a loved one may be experiencing a lacunar stroke should call for emergency medical assistance immediately. Prompt diagnosis and treatment, including medications to dissolve or prevent blood clots, are crucial for minimizing long-term impacts.

The takeaway

While lacunar strokes are often overlooked, they can have major long-term consequences, even when asymptomatic. Controlling risk factors like high blood pressure and diabetes, and seeking immediate medical care for suspected strokes, are important steps for preventing the serious health issues that can result from these small but impactful brain events.