There are limited data, mainly clinical and radiological, on small centrum
ovale infarcts (SCOIs). From a consecutive series of 159 autopsy brains we
identified 12 cases which on gross pathological examination harboured a tot
al of 21 SCOIs. In the majority of lesions histology revealed a significant
component of incompletely infarcted brain. Clinicopathological data sugges
ted that the underlying mechanism was likely to have been cardioembolic in
3 cases, and possibly embolic from heart or aortic arch in a further 5, Two
cases were due to ipsilateral carotid artery atheroma (i.e, 10 of 12 cases
had possible embolic sources). The majority of lesions appeared to lie in
arterial borderzones. The combined data suggest that SCOIs are pathological
ly and pathogenetically heterogeneous, and therefore that the term 'lacune'
is inappropriate because this implies intrinsic small vessel disease as th
e underlying cause. Clinically, potentially treatable cardiac and large ves
sel pathology should be excluded.