Lacunae are small, deep cerebral infarcts known to occur in hypertensive patients. Although frequently asymptomatic, they sometimes produce characteristic clinical syndromes. Postmortem studies have implicated small-vessel disease in their pathogenesis, and, as a result, conservative management has been advocated. Computed tomography (CT) has provided new insights into the spectrum of lacunar disease. Review of recently acquired information suggests modifications of the approach to these patients. The clinical lacunar syndromes, though nonspecific, do suggest lacunar infarction. In hypertensive patients with these syndromes and CT confirmation of lacunar infarction, a conservative diagnostic posture coupled with medical management of risk factors continues to be indicated.