To summarize the risk factors, clinical and imaging features of acute multiple lacunar infarctions in non-embolic stroke imaging mode, and to explore the possible factors causing the rapid progress of cerebral small vessel disease.

The clinical data of eligible patients from January 1, 2008 to December 31, 2017 in the First Medical Center of PLA General Hospital were collected. The imaging inclusion criteria were non-embolic, acute ischemic cerebral infarction in different terminal branch. The information of interest included baseline information (age, gender, body mass index), risk factors (hypertension, diabetes, coronary heart disease / myocardial infarction, hyperlipidemia, cerebrovascular history, smoking history, drinking history, and family history), and the imaging manifestations of cerebral small vessel disease (white matter Fazekas Scale score, lacunar infarct lesion, perivascular space, and microbleeds). Fisher’s exact test was used to compare the evaluation data of cerebral microangiopathy reported on cerebral infarction in China.

The incidence of lacunar infarction was significantly higher than the previously reported data of overall cerebrovascular disease (80.0% vs 44.1%, P=0.028). Although there was no significant difference of baseline information and risk factors (P＞0.05), the data showed that this group of patients had higher load of risk factors (multiple risk factors superimposed, poor risk factor control) and higher load of cerebral small vessel disease (more intensive white matter signal and increased lacunar infarction).

Poor management of multiple risk factors may be an important factor for the simultaneous occurrence of multiple lacunar infarctions in cerebral small vessel disease disease. More strict management of risk factors may be of benefit to the patients with multiple cerebral small vessel disease.