A 66-year-old man is brought to the emergency department because of weakness of his left leg for the past hour. He was unable to get out of bed that morning. His pants are soaked with urine. He has hypertension and coronary artery disease but he does not take his medications as prescribed. Examination shows intact cranial nerves and sensory function. The patient has 3/5 muscle strength on the right side. Initial CT scan without contrast reveals no abnormalities. Four weeks later, repeat brain imaging shows a 9-mm, fluid-filled cavitary lesion in the left internal capsule. This patient's condition is most likely caused by which of the following?

Question

A 66-year-old man is brought to the emergency department because of weakness of his left leg for the past hour. He was unable to get out of bed that morning. His pants are soaked with urine. He has hypertension and coronary artery disease but he does not take his medications as prescribed. Examination shows intact cranial nerves and sensory function.  The patient has 3/5 muscle strength on the right side.  Initial CT scan without contrast reveals no abnormalities.  Four weeks later, repeat brain imaging shows a 9-mm, fluid-filled cavitary lesion in the left internal capsule.  This patient's condition is most likely caused by which of the following?

Quizplus · Accepted Answer

Eductional Objective: Lacunar infarcts are small, ischemic infarcts (usually <15 mm) involving the deep brain structures (eg, basal ganglia, pons) and subcortical white matter (eg, internal capsule, corona radiata).  They most often occur due to hypertension, which causes hardening/thickening of the vessel wall (hypertensive arteriolar sclerosis), predisposing patients with this condition to thrombotic vessel occlusion.

A 66-Year-Old Man Is Brought to the Emergency Department Because