History and findings: A 29-year-old woman was admitted to hospital with an acute right-sided hemiplegia and sensory disorders, as well as upper right quadrant anopsia. There were no other significant abnormalities. She had previously been healthy and was free of any predisposing risk factors for thromboembolism. Neurological examination elicited a homonymous right upper quadrant hemianopsia, dysesthesia of the right half of the face and hypesthesia and hypalgesia of the right side of the body. In addition there was paresis of the right arm and a positive right Babinski reflex.
Investigations: There was no evidence for any underlying haematological, metabolic, infectious or vascular disease. Computed tomography of the head revealed a small hypodense area immediately adjacent to the posterior part of the left internal capsule, compatible with a lacunar infarction, a finding confirmed by magnetic resonance imaging and relating to the area supplied by the thalamic branch of the posterior cerebral artery. Transoesophageal echocardiography demonstrated a patent foramen ovale.
Treatment and course: Almost complete regression of all signs occurred within two months on anticoagulation with heparin intravenously for two weeks followed by oral phenprocoumon (Quick's value 30-40%) and intensive physiotherapy. Five weeks after onset of treatment the paresis was obviously regressing and pyramidal tract signs had disappeared. Sensitivity to touch over the right half of the body was still diminished and the homonymous paracentral scotoma still present.
Conclusion: Lacunar infarction of the brain in young patients has an excellent prognosis, as long as it is treated intensively according to its cause.