How do you evaluate and manage patients with recurrent multifocal subcortical ischemic infarcts of unclear etiology?

Presuming the search for a large vessel or cardiac source was negative, I would assume the cause is small vessel disease. To reduce the risk of recurrence, vascular risk factors such as hypertension and elevated cholesterol should be maximally controlled. An antiplatelet drug should also be used, ei...

Agree with above. Also, within the right clinical context (migraine headaches with aura, memory loss, young age), I would consider the diagnosis of CADASIL and check for a NOTCH3 mutation.

First and foremost, rule out cardiac embolus source, carotid artery disease, and any intracranial vascular abnormalities like AVM or Takayasu. In addition, need to rule out any hypercoagulable disorders.