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Reply from the Authors: The high risk of lacunar stroke associated with hypertension but absent risk with heart disease in our previous hospital-based case-control study [1] suggested to us that hypertensive lipohyalinotic lesions of small penetrating vessels are likely to be a common, but not unique, underlying mechanism of lacunar infarction, in accordance with the general concept of the lacunar hypothesis. [4] This clinical epidemiological, rather than pathological, study did not exclude the possibility of other lesions of small penetrating vessels to be contributing mechanisms of lacunar infarction. We were unable to assess whether there was only …
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