Didn't syphilis also take its toll?
There is a long discussion of the cause of Lenin's stroke at pp. 444-446 of Robert Service's *Lenin: A Biography*.
https://books.google.com/books?id=N9mbl_xbWpkC&pg=PT530
Service is in the end agnostic on the question of syphilis (some of Lenin's symptoms pointed in that direction, others didn't, some of his doctors thought he had it, others didn't, a Wasserman test supposedly turned out negative but the blood analyses have suspiciously gone missing, etc.). Grigori Rossolino, a Russian neuropathologist of Italian descent, bluntly told Lenin that he had *hoped* it was syphilis since that was at least curable but had concluded that the illness was even more serious than syphilis and the prognosis for the patient was not good.
In any event, while syphilis was a plausible diagnosis, so was cerebral arteriosclerosis. "Lenin's father had reportedly died of it in 1886 and might well have passed on the condition to his son. The subsequent medical history of the other Ulyanovs was to point in the same direction. Anna Ilinichna traveled incognito across the border to Latvia in 1922 [I think this is a misprint for 1933--DT] to a sanatorium, and she died after a stroke and chronic paralysis in 1935, two years later. Maria Ilinichna failed to survive a heart attack, and Dmitri Ilich died of stenocardia--the constriction of the blood vessels joined to the heart--in 1943."
Service concludes:
"But what really was wrong with him? Medical science has progressed in the ensuing decades and would be able, if Lenin were now a patient, to diagnose his illness more easily. One of the possible causes would no longer be seriously entertained: neurasthenia. Today this condition, so readily diagnosed until the middle of the twentieth century, is seldom recognized as a genuine disease. Of the three main remaining diagnoses each has something plausible about it. If it were not for the negative result of the Wasserman test, syphilis would be a credible guess. If it were not for the fact that he had had minor strokes before 1922, the surgical removal of the bullet might be credible. Yet the fact remains that some of Lenin's doctors believed he was syphilitic even though, apparently, he failed to come up positive on the Wasserman test. Nor can it be disproved that the operation on the bullet fatally worsened an existing condition. Then again perhaps Professor Osipov got it right when suggesting that Lenin was suffering from atherosclerosis or a 'hardening of the arteries'. Often it is associated with a high pressure of blood against the arterial walls. The affected arteries in Lenin's case, as was revealed after his death in 1924, were linked to the brain.
"In the West this is scarcely a topic of intense interest. In Russia, however, the communist authorities propagated an image of Lenin as a morally pure individual, and the consequence is that many contemporary historians have been searching to prove that he died of a venereal disease. Thus it is implied that he was sexually promiscuous. It is an understandable quest. But it is driven by motives outside the limits of medical history. And until further information comes to light, no useful conclusion may be offered."
