The small stroke that walks — lacunar pure motor
| Patient | 58F, acute phase |
|---|---|
| Lesion | MCA territory, minor |
| Severity | NIHSS 4 |
| Days since onset | 2 |
| Before the strokeIndependent; accounts clerk, cares for her mother. | |
| Also on the chartHypertension; Type 2 diabetes | |
| PrecautionsFatigue — schedule bouts before early afternoon | |
Test yourself
She walks already. What is today’s intervention?
The teaching
The lacunar case looks easy and that is the trap: the dose response of rehabilitation applies to small strokes too, the measure must have headroom for a patient who already walks, and the family conversation carries two truths at once — recovery is likely, and the conditions that caused this stroke are still in the room.
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the five-domain examination, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: AVERT Trial Collaboration group. Lancet. 2015. Winstein CJ et al. Stroke. 2016 · Moore JL et al. J Neurol Phys Ther. 2018 · Winstein CJ et al. Stroke. 2016