This chapter reviews the current literature on the frequency and causes of multiple brain infarcts, particular clinical and/or topographical patterns that suggest specific underlying mechanisms, and etiologies. The presence of multiple lacunar infarcts is an important prognostic indicator not only for functional recovery but also for a higher rate of recurrence. Various underlying conditions associated with multifocal involvement of the cerebral vasculature and/or a high rate of recurrent strokes may be responsible for multiple brain infarcts. Acute multiple infarcts may involve both hemispheres and may suggest some specific clinical pictures, particular causes, such as large artery disease, cardioembolism, angiitis, hematological disorders, hemodynamic mechanisms, or venous infarcts. In patients with simultaneous multiple, bihemispheric, and multilevel infarcts, most causes seem to be of similar type. Simultaneous multiple and multilevel infarcts may be associated with specific neurocognitive/psychological dysfunction patterns in most of the patients, allowing diagnosis accuracy.