I carefully read your query and I am sorry about your grandmother s health issues. The diagnosis of bilateral infarction would justify her symptoms. A lacunar infarction is small but since you say frontoparietal meaning involving two lobes I guess there must be multiple ones. Those infarctions have already happened now can t take them back but you can reduce the risk of further ones in the future by treating hypertension and high cholesterol you mentioned as well as with aspirin. The risk of her having a stroke will remain significant but by these measures we can lower it. As for the atrophy if severe it could be a sign of dementia, meaning a fall in her higher mental functions like memory, speech, judgement, complex tasks, planning and organizing, etc, if that is a case it is a progressive disease which could progress for years and render the patient unable to take care of herself and immobilized in bed. But I m saying that just because you asked for worse case scenario. At the moment there is no diagnosis of dementia if there are no higher mental signs you have noticed, it s not defined by atrophy, atrophy is an aging process which can be found also in old people without dementia. There are many types of dementia, most frequent is Alzheimer s disease, but if there is Parkinsonian syndrome it can manifest dementia in advanced stages, as well as imbalance. Regarding the treatment pacitane is used to treat parkinsonian tremor, but you should be careful in old people as at times it cause psychic symptoms like hallucinations, agitation. I hope to have been of help.