American Board of Psychiatry and Neurology (ABPN) Practice Exam

Lacunar strokes, which are small, deep strokes that occur due to the occlusion of small penetrating arteries supplying deep structures of the brain, are significantly influenced by multiple vascular risk factors, particularly hypertension. Among the given combinations, focusing on hypertension and tobacco smoking behavior is particularly crucial for prevention.

Hypertension is a well-established primary risk factor for lacunar strokes due to its damaging effects on small blood vessels, which can lead to their occlusion and subsequent ischemia. Tobacco smoking further compounds the risk by contributing to vascular damage, increasing blood pressure, and promoting atherogenesis, all of which can lead to worsening or new occurrences of stroke. This combination emphasizes a modifiable lifestyle risk factor (smoking) alongside a critical medical issue (hypertension).

Other combinations may include elements that are beneficial for general stroke prevention but do not specifically address the small vessel disease primarily responsible for lacunar strokes. For instance, while hyperlipidemia and diabetes contribute to overall cardiovascular risk, they are less directly linked to the mechanisms underlying lacunar stroke than the interaction between hypertension and smoking. Thus, focusing on controlling hypertension and addressing tobacco use provides a targeted approach to prevention.