Cerebrovascular Disease USMLE Step 1 Practice Question
A 55-year-old woman with a 10-year history of poorly controlled hypertension presents to the emergency department with acute onset severe headache, nausea, and vomiting. On examination, she has right-sided hemiplegia and mild aphasia. Vital signs: BP 188/118 mmHg, HR 88/min, RR 16/min, temperature 37.1°C, SpO2 99% on room air. Non-contrast CT head shows a 3.2 cm hyperdense lesion in the left basal ganglia with surrounding low-attenuation edema and 8 mm midline shift. Laboratory studies reveal INR 1.0, platelet count 245,000/μL, PT/PTT normal, and hemoglobin 13.5 g/dL. The patient denies recent trauma, anticoagulant use, or antiplatelet therapy beyond aspirin. Which of the following is the most likely diagnosis?
Answer choices
- AAcute ischemic stroke with hemorrhagic transformation
- BHypertensive emergency with posterior reversible encephalopathy syndrome (PRES)
- CAcute epidural hematoma from occult head trauma
- DHypertensive intracerebral hemorrhageCorrect answer
- EAcute subdural hematoma with coagulopathy
- FCardioembolic stroke with secondary hemorrhage
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