Background: Single small subcortical infarction (SSSI) in the territory of the middle cerebral artery (MCA) may be classified as proximal SSSI (pSSSI) or distal SSSI (dSSSI) according to its extension to the MCA. We sought to investigate the outcome of different types of SSSIs. Methods: We assessed 177 patients who had an SSSI (67 pSSSI and 110 dSSSI) in the perforator territory of MCA. The clinical characteristics, neurologic status (initial National Institutes of Health Stroke Scale score at admission and modified Rankin Scale [mRS] score at 1 year), and clinical treatments at 1 year were evaluated. Results: Among the 177 patients, 130 had favorable (mRS score # 1) and 41 had unfavorable outcome (mRS score $ 2) at 1 year, dSSSI had higher mRS than pSSSI at 1 year (1 [0- 2] versus 0 [0- 1]; P 5.013). The age (odds ratio [OR] 1.049, 95% confidence interval [CI] 1.002- 1.098; P 5.041) and distal location of the lesion (OR 2.687, 95% CI 1.039- 6.948; P5.042) were found to be independent risk factors of 1- year unfavorable outcome of SSSIs. Conclusions: SSSI has a heterogeneous outcome at 1 year according to the lesion location.