Introduction: Although dysarthria-clumsy hand syndrome (DCHS) is a well known, infrequent subtype of lacunar syndrome, there is little information on its anatomic specificity, spectrum of associated clinical characteristics, and etiological mechanisms. Clinically lacunar syndromes are classified according to Fisher's criteria into pure motor hemiparesis, sensorimotor stroke and ataxic hemiparesis including DCHS. We present the clinical description of DCHS based on data collected prospectively in our stroke unit. Methods: From 414 acute ischemic stroke patients included in a hospital based prospective study over a 2-year period, 83 patients with lacunar strokes and 6 patients having DCHS were identified. Ali participants underwent an evaluation including medical history, physical examination, standardized blood tests, extracranial Doppler ultrasonography, electrocardiogram, a brain computed tomography and/ or magnetic resonance imaging, and echocardiography; and ali were classified according to TOAST criteria. Results: DCHS accounted for 1.4% of ali acute ischemic stroke, and 7.2% of ali lacunar syndromes. The investiagtions on the underlying etiology supported the lacunar hypothesis in all patients presenting with DCHS, and no patients with DCHS had an atherotrombotic/cardioembolic origin nor intracerebral haemorrhage. The internal capsule (66.6%, n=4), pons (16.6%, n=l), and basal ganglia (16.6%, n=l) localizations found to be associated with DCHS. Outcome was favorable in compared with other types of strokes (symptom free at discharge 66.6%, n=4). Conclusion: To present the etiology and risk factors underlying classical lacunar strokes will help better understanding of these subtype of infarctions and differentiate from small infarctions caused by other etiologies.