In particular, whereas depressive symptoms are similar between the two groups, executive dysfunction and deficit of information processing speed are more frequently reported in patients with WMLs than in those with lacunar state [19, 25, 26].
 the exon 19 with involvement Notch3 gene of the external capsule Pennisi NINDS-AIREN Lacunar state No et al.
In view of these findings, BD and the lacunar state
could be the same entitye [20, 21].
We describe a 51-year-old woman with a new onset BD type II secondary to a lacunar state of the basal ganglia, analyzing the clinical and neuropsychological features and formulating an anatomopathophysiological hypothesis.
Cerebral MR revealed multiple bilateral subcortical lacunar lesions both within the periventricular region and at the nucleuscapsular level resulting in a lacunar state (Figure 1).