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These authors report three cases in which a recurrent stroke in the hemisphere opposite the original stroke unexpectedly caused worsening of hemiparesis ipsilateral to the recurrent stroke. The hemiparesis had resulted from an earlier stroke due to cerebral large-vessel disease. In all cases, the recurrent stroke did not produce contralateral hemiparesis because the recurrent stroke was small-sized (lacunar), was localized in the “extrapyramidal” motor pathway (including the thalamus, globus pallidus, and corona radiata), and spared the internal capsule. The authors speculate that the extrapyramidal motor pathway connected to the uncrossed cerebrospinal tract (CST) ipsilateral to the hemiparesis had been reorganized after the first stroke a…