Which symptom is NOT typically associated with a lacunar stroke?

A lacunar stroke is characterized by small, deep infarcts in the brain due to the occlusion of small penetrating arteries. The symptoms that arise from lacunar strokes tend to reflect damage to specific pathways in the brain, leading to motor or sensory deficits but generally sparing higher cognitive functions.

The option indicating high cognitive impairment is correct because lacunar strokes typically do not involve large areas of brain responsible for higher cognitive processes. Symptoms often manifest as pure motor or sensory deficits, such as weakness or numbness, and these disturbances usually do not include significant cognitive decline. In fact, individuals post-lacunar stroke may retain intact cognitive abilities, especially when the stroke affects pure motor or sensory areas.

The onset of symptoms in lacunar strokes can be sudden or sometimes insidiously gradual, which aligns with the rapid nature of blood supply interruption in small vessels. Higher cortical functions, such as complex thinking and problem-solving, remain relatively unharmed, which reinforces the distinct clinical presentation associated with lacunar strokes compared to larger strokes that may impact wider cerebral areas affecting cognition.