Seizure Disorders USMLE Step 1 Practice Question
A 72-year-old man with a 10-year history of hypertension presents to the emergency department with a generalized tonic-clonic seizure. His wife reports he suffered an acute ischemic stroke 8 days ago affecting the left motor cortex, which caused transient right-sided weakness that has since mostly resolved. On examination, the seizure originated with focal jerking of the right hand before generalizing. Vital signs: BP 162/94 mmHg, HR 102 bpm, RR 18/min, Temperature 37.1°C, SpO2 99% on room air. CT head shows hypodensity in the left motor cortex consistent with subacute infarction without hemorrhage. Which of the following mechanisms best explains why this patient developed a seizure in the early post-stroke period?
Answer choices
- ACortical gliosis and scar formation around the infarct creating chronic irritable foci
- BAcute ischemic injury with ionic imbalance (K+ release, Ca2+ influx) and glutamate excitotoxicityCorrect answer
- CHemorrhagic transformation of the ischemic stroke with blood breakdown products
- DElevated blood pressure during acute stroke phase directly triggering seizure activity
- ERecurrent microemboli from atrial fibrillation progressively lowering seizure threshold
- FAcute cerebral edema causing mass effect on adjacent cortical tissue
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