This 56-year-old woman with history of uncontrolled arterial hypertension had sudden onset of left hemibody paresthesias, followed by left upper and lower extremity weakness, and adventitious movements of her left upper extremity.

Our patient had sudden left hemibody numbness and mild weakness, followed by random jerking, involuntary movements of her left hand and arm. Her adventitious movements disappeared during sleep. She did not have facial grimacing or tongue protrusion. MRI showed a lacunar infarction of the contralateral putamen and caudate nucleus with sparing of the anterior limb of the internal capsule. Random blood sugar and thyroid function tests were normal. Remainder of ancillary investigations were unremarkable.

Lacunar infarcts involve deep regions of the brain or brainstem. The most frequent sites of involvement are the putamen, basis pontis, thalamus, posterior limb of the internal capsule, and caudate nucleus. Multiple lacunae are associated strongly with arterial hypertension and diabetes mellitus. Lacunar infarcts are often associated with in situ occlusion of a single perforating vessel or thickening of the arteriolar wall. Lacunar infarcts can also be caused by a different etiology than hypertensive small vessel cerebral disease, including cardiac embolism, and embolism from artery to artery atheroma or intracranial arterial stenosis.