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A 56 year-old man with poorly controlled hypertension presented with symptoms of weakness involving the right face and body.
MRI axial images: (Left ) Diffusion weighted image; (Right) Flair image. Note in the flair image, numerous white matter lesions, consistent with small vessel disease. The new stroke is not well seen. However, on the diffusion scan (left), the presence of a new lacunar stroke in the left internal capsule is obvious. 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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