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Pure Motor Hemiparesis – Lacunar Syndrome — SCE Neurology MCQ

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EasyCerebrovascular DiseasePure Motor Hemiparesis – Lacunar SyndromeSCE Neurology

A 60-year-old man with ischaemic stroke has a pure motor hemiparesis affecting his right face, arm, and leg equally. He has no sensory loss, no visual field defect, no aphasia, and no neglect. MRI brain shows a small lacunar infarct in the posterior limb of the left internal capsule. What type of stroke is this?

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Correct answer: A — Lacunar stroke — a small vessel occlusion causing a classic lacunar syndrome

Pure motor hemiparesis is one of the five classical lacunar syndromes (along with pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and dysarthria-clumsy hand). It results from a small vessel occlusion causing a lacunar infarct, most commonly in the posterior limb of the internal capsule (where motor fibres for face, arm, and leg are compactly arranged) or the basis pontis. The hallmark of lacunar syndromes is the ABSENCE of cortical signs (no aphasia, neglect, hemianopia, or higher cortical dysfunction). A: No large vessel occlusion — the syndrome is classic lacunar. C: The absence of cortical signs argues against cardioembolism. D: MRI shows infarct, not haemorrhage. E: Internal capsule is anterior circulation.

Reference: RCP Stroke Guidelines; TOAST Classification