Several years prior to this assessment, this 82-year-old left-handed woman with hypertension and hyperlipidemia had sudden onset of right-sided weakness and slurred speech. On admission, she was also found to have an inferior wall myocardial infarction.

Most ischemic strokes result from disease of large- and medium-sized extracranial or intracranial arteries, cardiac embolism, or small vessel disease (lacunar infarctions). Rare causes of ischemic stroke include cervicocephalic arterial dissections and other nonatherosclerotic vasculopathies, border-zone infarcts due to arterial hypotension and poor cerebral perfusion, and hypercoagulable states. Approximately 20% of strokes are due to lacunar infarctions. The risk of recurrent stroke is lowest for lacunar strokes; the overall stroke recurrence rate among patients with lacunar infarctions within 3 months is 1.2%, but this rate may increase up to 10% among those with poorly controlled hypertension and diabetes (an association not shared by hyperlipidemia). Patients with a lacunar stroke index event are equally likely to have recurrent small or large vessel ischemic strokes.