Lacunar infarct — SCE Neurology MCQ

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HardStrokeLacunar infarctSCE Neurology

A patient has sudden pure motor weakness of face, arm and leg without aphasia, neglect, visual-field loss or cortical sensory deficit. MRI shows a small acute posterior-limb internal-capsule infarct. Which stroke mechanism is most likely?

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Correct answer: D — A perforating small-vessel lacunar infarct

The best answer is “A perforating small-vessel lacunar infarct”. A compact capsular corticospinal and corticobulbar lesion produces pure motor lacunar syndrome; absence of cortical signs supports a perforator mechanism, although routine vascular and cardiac risk evaluation remains appropriate. “A dominant-hemisphere cortical embolus” is less appropriate because a cortical embolus commonly produces aphasia, neglect, gaze or sensory integration signs “A posterior cerebral artery occipital infarct” is less appropriate because occipital infarction primarily causes visual-field loss “A cerebral venous sinus thrombosis” is less appropriate because venous thrombosis often causes headache, seizures or non-arterial lesions “A neuromuscular-junction disorder” is less appropriate because junctional weakness does not create an acute diffusion-positive internal-capsule lesion

Reference: NICE NG128: Stroke and transient ischaemic attack in over 16s. https://www.nice.org.uk/guidance/ng128/chapter/recommendations