We reviewed computed tomograms and clinical characteristics for 1,124 consecutive stroke patients from Shanghai, People's Republic of China. While there were many similarities between lacunar syndromes in these patients and patients from Europe and the United States, several differences were noted. Deep cerebral infarcts identified by computed tomography were more common in patients from Shanghai and accounted for 27% of all ischemic infarcts. Small deep infarcts occurred more commonly in women from Shanghai (44%) than in women from the West. Deep cerebral infarcts in patients from Shanghai were larger than those usually seen in patients from the West. The mean infarct volume in patients from Shanghai was 2.4 ml, and 49% were giant lacunes (greater than 15 mm in maximal diameter).