In magnetic resonance imaging, cerebral infarcts are depicted as hyperintensity areas on T2-weighted images, whereas old intracerebral hemorrhages appear as hypointensity areas with or without hyperintensity areas on T2-weighted images. Ischemic and hemorrhagic lesions can thus be distinguished by this technique. In 92 patients with multiple lacunar infarction diagnosed by clinical history and CT findings, high-field magnetic resonance imaging was used to evaluate the prevalence and distribution of coexisting old intracerebral hemorrhages. Old hemorrhages were found in 15 of 92 patients. All the old hemorrhages were small and located in the thalamus, putamen, pons or cerebellar hemispheres, which are common sites of hypertensive intracerebral hemorrhage. The hemorrhages were single in 7 patients and multiple in the other 8. Eleven patients had a history of one or two minor episodes corresponding to the old hemorrhages, although the other 4 had no episodes corresponding to the hemorrhages. Small intracerebral hemorrhage often presents as a lacunar syndrome, and CT is unable to distinguish it from lacunar infarction, if performed during the chronic phase of ictus. Multiple lacunar infarction diagnosed by CT and history may include several old cerebral hemorrhages.