Multiple lacunar cerebral infarcts that remain lethargic may have cortical damage, temporal lobe damage, or brainstem damage. A patient may be in a lethargic state if he or she is difficult to arouse, requires strong stimulation to wake up, and cannot answer questions properly. Multiple lacunar cerebral infarcts can lead to ischemia and hypoxia of the brain tissue, and when the cerebral cortex is damaged, the patient may show symptoms of being asleep all the time. Repeated subcortical infarctions can also lead to vascular dementia, resulting in cognitive decline. If the patient has temporal lobe damage or brainstem damage, he or she is prone to decreased level of consciousness and lethargy. If a person with multiple lacunar infarctions is lethargic or has persistent symptoms that do not improve, it is important to seek medical attention.