Certified Neuroscience Registered Nurse (CNRN) Practice Exam

Which of the following conditions is most likely to lead to lacunar strokes?

1. Chronic migraines

2. Severe head trauma

3. Systemic lupus erythematosus

4. Chronic hypertension

The correct answer is: Chronic hypertension

Chronic hypertension is a significant risk factor for lacunar strokes because it leads to small vessel disease. In the context of brain health, chronic high blood pressure causes changes in the small penetrating arteries which supply deep structures of the brain, leading to lipohyalinosis (the degeneration of the small blood vessels). This degeneration can result in ischemic lesions, which are the hallmark of lacunar strokes. These small, deep strokes commonly occur in areas such as the thalamus or basal ganglia and are directly linked to long-standing high blood pressure. In contrast, while chronic migraines, severe head trauma, and systemic lupus erythematosus can contribute to various neurological complications, they do not primarily cause the small vessel changes that directly lead to the occurrence of lacunar strokes. Understanding the pathophysiology behind lacunar strokes and their association with chronic hypertension is crucial for effective prevention and management in patients at risk.