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A 67 year-old man with poorly controlled hypertension presented with symptoms of weakness involving the right face and body.
MRI axial images: (Left) Flair image; (Right) Diffusion weighted image. Note in the flair image, numerous white matter lesions, consistent with small vessel disease. However, it is not possible to discern which are new and which are old. This is the major advantage of diffusion weighted imaging. On the diffusion image on the right, note the obvious bright signal in the left posterior limb of the internal capsule. This is the acute lacunar stroke that accounts for the patient's symptoms. Lacunar strokes are caused by occlusion of the deep perforating blood vessels (also known as small vessel disease or lacunar strokes). Small vessel disease is most commonly associated with hypertension and diabetes. There are several classic lacunar syndromes, including pure motor hemiparesis, ataxic hemiparesis, clumsy hand-dysarthria (lesions either in the internal capsule or basis pontis) and pure sensory stroke (lesion in the thalamus).
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