Objective. To determine the structural-morphometric peculiarities of the brain in patients with lacunar ischemic stroke and their influence on cognitive functions. Material and methods. A morphometric analysis of brain CT was performed in 48 patients in the acute period of lacunar stroke. The width of subarachnoid spaces at the pole of the frontal lobes and the lateral sulcus was measured in axial sections, the ventricular system was assessed be several parameters. To adjust for the total head size, the data were evaluated as ratios. Mean populations values adjusted for age were used as normal values. Cognitive functions were measured with the MoCA scale. Results. It was determined that 71% of the patients had lacunar stroke as a result of the atrophic process in the brain. Atrophic process of the brain was often diagnosed in the age group of 61-70 years, multiple lacunar lesions were diagnosed in the group of 51-60 years. Cognitive functions were impaired in 91% of the patients in the acute period of lacunar stroke. Conclusion. Correlations between the level of cognitive functions and morphometric markers of subcortical atrophy demonstrate the leading role of the subcortical atrophy in the development and progression of cognitive deficit.