Cerebrovascular Disease USMLE Step 1 Practice Question
A 61-year-old man with a history of hypertension and chronic kidney disease (stage 3b) presents to the emergency department with acute-onset left facial droop, left arm weakness, and dysarthria. The symptoms began 2.5 hours ago. Vital signs are BP 168/94 mmHg, HR 88 bpm, RR 16, temperature 37.2°C, and SpO2 98% on room air. Non-contrast head CT and CT angiography show no evidence of acute ischemia or hemorrhage. The patient receives intravenous alteplase 0.9 mg/kg (maximum dose) within the therapeutic window. Four hours after thrombolysis, the patient develops severe occipital headache and progressive altered mental status. Repeat non-contrast head CT demonstrates a hyperdense signal in the territory of the right middle cerebral artery with mild mass effect. Which of the following complications has most likely occurred?
Answer choices
- AReocclusion of the middle cerebral artery from rethrombosis despite thrombolysis
- BHemorrhagic transformation of the acute ischemic infarctionCorrect answer
- CAcute hypertensive emergency secondary to pain and anxiety from thrombolysis
- DSubarachnoid hemorrhage from rupture of an undiagnosed aneurysm
- ESubdural hematoma from a fall during acute stroke symptoms
- FIntracerebral hemorrhage from acute severe hypertension unrelated to thrombolytic therapy
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.