Neuroimaging: lacunar infarct: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: lacunar infarct

Sample item

A hypertensive diabetic man has pure motor hemiparesis. MRI shows a 10 mm diffusion-restricting lesion in the posterior limb of the internal capsule. Which vascular pathology underlies this infarct?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Lipohyalinosis of small penetrating arteries

Lacunes are small deep infarcts in the basal ganglia, internal capsule, thalamus and pons, from disease of single penetrating arteries. Hypertension and diabetes cause lipohyalinosis and microatheroma in these vessels.

Option by option

  • A. Haemodynamic watershed failure

    Watershed infarcts lie between territories at the cortical border zones.

  • B. Lipohyalinosis of small penetrating arteries (correct)

    Correct. Penetrating artery disease from hypertension and diabetes causes lacunar infarcts.

  • C. Cardioembolism from atrial fibrillation

    Cardioembolism usually causes larger cortical or wedge-shaped infarcts.

  • D. Atherothrombosis of the internal carotid artery

    Large artery atherothrombosis produces larger territorial or artery-to-artery embolic infarcts.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, Lipohyalinosis of small penetrating arteries. Lacunes are small deep infarcts in the basal ganglia, internal capsule, thalamus and pons, from disease of single penetrating arteries.

Why is "Haemodynamic watershed failure" not the answer?

Watershed infarcts lie between territories at the cortical border zones.

Why is "Cardioembolism from atrial fibrillation" not the answer?

Cardioembolism usually causes larger cortical or wedge-shaped infarcts.

Why is "Atherothrombosis of the internal carotid artery" not the answer?

Large artery atherothrombosis produces larger territorial or artery-to-artery embolic infarcts.

What concept does this question test?

It tests Neuroimaging: lacunar infarct in Radiology. Hypertension and diabetes cause lipohyalinosis and microatheroma in these vessels.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: lacunar infarct?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.