Cerebrovascular Disease USMLE Step 1 Practice Question
A 64-year-old woman with a 15-year history of hypertension and chronic kidney disease stage 4 presents to the emergency department with acute onset severe frontal headache, confusion, and right-sided weakness. Her daughter reports she ran out of antihypertensive medications 2 weeks ago. Vital signs: BP 245/165 mmHg, HR 102 bpm, RR 20, temperature 37.3°C, SpO2 98% on room air. On neurologic examination, she has expressive aphasia and right hemiparesis. Non-contrast CT head shows a 3 cm acute intraparenchymal hemorrhage in the left basal ganglia with extension into the lateral ventricle. Laboratory studies: serum creatinine 3.1 mg/dL, BUN 68 mg/dL, hemoglobin 9.2 g/dL, platelets 245,000/μL, INR 1.0. No recent anticoagulation or antiplatelet use is documented. Which pathophysiologic mechanism most directly explains the hemorrhagic stroke in this patient?
Answer choices
- AHypertensive microangiopathy with fibrinoid necrosis of penetrating arteriesCorrect answer
- BRupture of a saccular aneurysm at the circle of Willis due to chronic hypertension
- CThrombotic microangiopathy from acute kidney injury causing endothelial damage
- DAmyloid angiopathy deposition in cortical vessels from chronic renal failure
- EArterial dissection of the left middle cerebral artery from hypertensive surge
- FHemorrhagic transformation of an acute ischemic stroke from impaired fibrinolysis
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