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Chapter 6. Stroke

Which of the following statements accurately describes the acute presentation of ischemic stroke?

a. Acute infarction of the central nervous system tissue, one-sided weakness, systolic blood pressure >200 mm Hg

b. Neurologic dysfunction without infarction, one-sided weakness, visual impairment

c. Acute infarction of the central nervous system tissue, one-sided weakness, visual impairment

d. Neurologic dysfunction without infarction, one-sided weakness, blood glucose >200 mg/dL

Answer c is correct. Acute ischemic stroke is caused by a local thrombus formation leading to acute infarction. Visual impairment, weakness on one side of the body, and inability to speak are all other common symptoms of acute stroke.

Answer a is incorrect. Patients do commonly present with one-sided weakness; however, they may or may not present with elevated blood pressure. Further, there is not an upper limit of systolic blood pressure that is indicative of acute ischemic stroke.

Answer b is incorrect. Stroke is defined as infarction of the central nervous system tissue. Neurological dysfunction without acute infarction is a TIA. Patients do commonly present with one-sided weakness and visual impairment. They may also present with the inability to speak.

Answer d is incorrect. Stroke is defined as infarction of the central nervous system tissue. Neurological dysfunction without acute infarction is a TIA. Patients do commonly present with one-sided weakness, and, while diabetes is a risk factor for having an ischemic stroke, there is not a correlation with elevated blood glucose levels and acute stroke.

JS is a 78-year-old white woman with a PMH significant for atrial fibrillation, systolic heart failure with an ejection fraction of 35%, and hypertension. She presents to the emergency department with symptoms of right-sided paralysis. She is not able to communicate, but her family member states that the symptoms began approximately 5 hours ago. MRI of the brain confirms the patient has had an ischemic stroke. At home she takes metoprolol 100 mg po bid, lisinopril 40 mg po daily, and furosemide 20 mg po daily. Which of the following medications would be the most appropriate for secondary stroke prevention in JS?

a. Ticlopidine

b. Clopidogrel

c. Warfarin

d. Extended-release dipyridamole plus aspirin

Answer c is correct. Oral anticoagulant therapy is the most effective treatment option for the secondary prevention of stroke in patients with a cardioembolic source (atrial fibrillation). All patients with atrial fibrillation should be on antithrombotic therapy with warfarin, dabigatran, apixaban, rivaroxaban, or aspirin for primary stroke prevention. The decision ...

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