A 70-year-old man presents with sudden-onset right-sided weakness and slurred speech. He has a history of hypertension and type 2 diabetes. His current medications include amlodipine and metformin. CT scan of the head is unremarkable. The physician suspects a lacunar stroke. Which imaging modality is most appropriate to confirm the diagnosis of a lacunar stroke?
A 70-year-old male presents with sudden difficulty speaking and clumsiness in his right hand. He has no weakness in his limbs. MRI shows a small infarct in the left pons. His medical history is significant for hypertension. His current medications include aspirin and hydrochlorothiazide. Which of the following is the most likely lacunar syndrome in this patient?
A 58-year-old female presents with sudden numbness and tingling in her left arm and leg. She has no weakness or other neurological deficits. MRI shows a small infarct in the right thalamus. She has a history of diabetes and hypertension. She smokes one pack of cigarettes a day. Which of the following is the most likely clinical syndrome associated with this patient’s presentation?
A 67-year-old man with a history of poorly controlled hypertension and type 2 diabetes presents with sudden-onset weakness in the right arm and leg. He denies any facial drooping, slurred speech, or changes in vision. Neurological examination reveals 2/5 motor strength in the right arm and leg, intact sensation, normal speech, and no cranial nerve deficits. Which of the following lacunar syndromes best explains this presentation?
A 65-year-old woman with well-controlled diabetes and a history of smoking presents with sudden onset of ataxia and dysarthria but no sensory loss or hemiparesis. An MRI reveals a small lesion in the pons. What is the most common underlying pathology leading to this type of stroke?
A 70-year-old man with a history of hypertension presents to the emergency department with sudden onset of right-sided weakness and difficulty speaking. His symptoms are mild, and he is alert and oriented. An MRI of the brain shows a small lesion in the basal ganglia. Which type of stroke is most likely based on the MRI findings in this patient?
A 64-year-old man presents to the emergency department with sudden-onset weakness in his right arm and leg, which he noticed upon waking up. He denies any speech difficulties, facial drooping, or visual disturbances. There is no headache, loss of consciousness, or chest pain. His past medical history includes hypertension and type 2 diabetes, both poorly controlled. He is a smoker with a 40-pack-year history and has not taken his antihypertensive medications regularly. Physical Examination: Vital Signs: Blood Pressure: 180/95 mmHg Heart Rate: 82 bpm Respiratory Rate: 16 bpm Temperature: 37°C Neurological Examination: Motor strength: 2/5 in the right arm and leg, normal on the left side Sensation: Intact bilaterally Cranial nerves: No deficits Speech: Normal Cerebellar signs: None noted Gait: Unable to walk due to right-sided weakness Diagnostic Workup: CT scan of the head (non-contrast): No acute intracranial hemorrhage or large infarction. MRI of the brain (with diffusion-weighted imaging): Small, acute infarction in the left posterior limb of the internal capsule. Carotid Doppler ultrasound: No significant carotid stenosis. Echocardiogram: No evidence of thrombus or cardiac embolism. Bloodwork: Glucose: 220 mg/dL HbA1c: 8.5% LDL: 140 mg/dL Complete blood count and coagulation panel: Normal Diagnosis: Lacunar stroke affecting the left internal capsule, likely secondary to small vessel disease related to chronic hypertension and diabetes. Which of the following best explains the underlying pathophysiology of a lacunar stroke?
A 52-year-old female presents to the hospital with a sudden severe headache, nausea, and neck stiffness. Imaging confirms a subarachnoid hemorrhage (SAH) due to a ruptured aneurysm. She is initially stabilized, but on day 7 of her hospital stay, she develops confusion, slurred speech, and weakness in her left arm. These symptoms suggest delayed cerebral ischemia (DCI), a known complication of SAH that can occur several days after symptom onset, leading to acute worsening of the neurologic exam and increased morbidity. What is the most likely underlying mechanism responsible for her new symptoms?
A 54-year-old woman presents to the emergency department with a sudden, severe headache described as the “worst headache of her life.” A CT scan of the head reveals a subarachnoid hemorrhage (SAH). She is admitted to the ICU and undergoes aneurysmal coiling. On day 6 post-SAH, she develops new-onset confusion and right-sided weakness. A repeat CT scan shows no new bleeding. What is the most likely cause of this patient’s new neurological deterioration?
A 60-year-old woman presents for a follow-up visit one month after experiencing a left middle cerebral artery infarction that was treated with intravenous tissue plasminogen activator (tPA). Her medical history is significant for newly diagnosed atrial fibrillation and hypertension. Which of the following is the most appropriate management strategy to prevent future cerebrovascular events?
