Certified Neuroscience Registered Nurse (CNRN) Practice Exam

Which factor is considered the greatest risk for lacunar strokes?

1. Obesity

2. Hypertension

3. Diabetes Mellitus

4. High Cholesterol

The correct answer is: Hypertension

Hypertension is recognized as the greatest risk factor for lacunar strokes due to its direct impact on the small penetrating arteries of the brain. Lacunar strokes occur when there is a blockage of these small vessels, leading to localized areas of ischemia or infarction. Hypertension causes both structural changes in the cerebral vasculature, such as lipohyalinosis (a degenerative change in small arteries), and increases the risk of atherosclerosis, both of which elevate the likelihood of small vessel occlusion. The relationship between hypertension and lacunar strokes is significant, as sustained high blood pressure can lead to chronic changes in the vessels and ultimately to the development of small vessel disease. Effective management of hypertension has been shown to reduce the incidence of lacunar strokes, emphasizing its role as a primary modifiable risk factor in prevention strategies. While other factors like obesity, diabetes mellitus, and high cholesterol contribute to stroke risk overall, they do so via mechanisms that often increase hypertension or are secondary pathways, making hypertension the most critical factor specifically for lacunar strokes.