Objective: To analyze the related risk factors in patients of cerebral infarction with leukoaraiosis and to investigate their pathogenesis. Methods: The clinical data of 216 patients with acute cerebral infaretion were analyzed retrospectively. The patients were divided into a cerebral infarction with leukoaraiosis group (n = 43) and a cerebral infarction without leukoaraiosis group (n = 173) according to brain CT or magnetic resonance imaging (MRI) findings. The risk factors for cerebrovascular diseases, the location and size of cerebral infarction, and the diseased vessels and collateral circulation were compared between the two groups. Results: (1)Logistic regression analysis showed that anterior circulation lesion (OR 7. 165; 95% CI 3. 072 to 16. 714), hypertension (OR 3. 135; 95% CI 1.090 to 9.013) and advanced age OR 1. 119; 95% CI 1. 067 to 1. 174) were the independent risk factors for patients of cerebral infarction with leukoaraiosis. (2)Among the 43 patients in the cerebral infarction with leukoaraiosis group, the infarctions of 27 patients (62. 8%) were in the basal ganglia or subcortical white matter, and 18 patients (41.9%) had lacunar infarction; 173 patients in the cerebral infarction without leukoaraiosis group were 46 (26.6%) and 18 (10.4%), respectively, and there were significant differences between the 2 groups (P = 0.000). (3)Twenty-seven and 41 patients had anterior circulation lesions in both groups (X 2 = 7. 890,P <0.05). Six patients (22.2%) developed anterior circulation lesions and 12(44.4%) had vascular occlusion in the cerebral infarction with leukoaraiosis group; there was no anterior circulation lesion (P =0.003), and 37 patients had vascular occlusion (90. 2%) in the cerebral infarction without leukoaraiosis group, there were significant differences between the 2 groups (P <0.01). The patency rate of collateral circulation had no significant difference between the 2 groups. Conclusion: Small cerebral-vessel and anterior circulation lesions are the pathophysiological basis of the patients of cerebral infarction. with leukoaraiosis.