A 70-year-old hypertensive woman presents with sudden-onset pure motor hemiparesis affecting the face, arm, and leg equally, without sensory loss, cortical signs, or visual field defect. MRI DWI shows a small lacunar infarct in the internal capsule. Which small vessel syndrome is this?

• A Pure sensory stroke
• B Sensorimotor stroke
• C Ataxic hemiparesis
• D Pure motor hemiplegia (PMH) ✓

Explanation

Pure motor hemiplegia (PMH) is the most common lacunar stroke syndrome, classically presenting with complete hemiplegia of the face, arm, and leg without sensory, visual, or cortical deficits. The lesion is in the posterior limb of the internal capsule or basis pontis, where the corticospinal tract fibres are densely packed in a small area. Pure sensory stroke involves the thalamus (VPL nucleus). Ataxic hemiparesis involves ipsilateral hemiataxia with contralateral hemiparesis, usually from basis pontis or internal capsule. Sensorimotor stroke involves the thalamocapsular region.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.