Recall that you met Mr. C in the Patient Education section of this Module. He has just been told that a brief episode in which he couldn't talk clearly was most likely a TIA. The physicians in the emergency department and the consulting neurologist have both recommended that additional testing be done immediately in order to determine more precisely what has caused his problem. However, Mr. C is very reluctant to have any more tests at this time. He has a vacation planned to the Grand Canyon and asks you, "Doctor, can't this wait?" Why would you strongly urge him to have those tests right now? List at least one piece of information that supports your position; list two for a bonus.

This is the brain of a patient who was seen in the emergency department after the abrupt onset of one-sided paralysis and sensory loss. He became progressively less alert, lapsed into a coma, and died about 36 hours later. This is what his brain looked like. Which one of the following is the most likely mechanism underlying the stroke that he suffered?

a. Cardiac embolus causing blockage of the large artery that supplies the lateral surface of the cerebral hemisphere
b. Thrombus that has formed on a ruptured atheromatous plaque located at the bifurcation of the common carotid
c. Rupture of a small penetrating artery that supplies deep interior structures of the brain
d. Reduction of cardiac output due to myocardial infarction, with resulting decrease in cerebral blood flow

Which one of the following statements about stroke is false?

a. Ischemic strokes are more common than hemorrhagic strokes
b. Hemorrhagic strokes usually involve large arteries, while ischemic strokes involve only small arteries
c. Ischemic strokes may be preceded by brief TIAs, whereas hemorrhagic strokes are not
d. Hypertension increases an individual's risk of both hemorrhagic and ischemic stroke
e. Ischemic strokes may be caused by embolization of thrombus from diseased cerebral arteries or the heart

What lobes of the brain have been infarcted in this specimen?

This CT scan (no contrast) was done in the emergency department about 2 hours after the patient experienced the sudden onset of left-sided paralysis and sensory loss. Does the area of hyperdensity ("white" area) represent:

a. hemorrhage
b. ischemic tissue

Why would you strongly urge him to have those tests right now? List at least one piece of information that supports your position; list two for a bonus.

Your Answer	We Were Looking For:
	The risk of stroke following a TIA is greatest in the first month, and remains high for the first year. Having had a TIA, he has about a 5% annual risk of stroke, and about an 8% combined annual risk of stroke, heart attack, or death in the next 5 years.

This is the brain of a patient who was seen in the emergency department after the abrupt onset of one-sided paralysis and sensory loss. He became progressively less alert, lapsed into a coma, and died about 36 hours later. Which one of the following is the most likely mechanism underlying the stroke that he suffered?

Your Answer	Correct Answer:
a. Cardiac embolus causing blockage of the large artery that supplies the lateral surface of the cerebral hemisphere	a. Cardiac embolus causing blockage of the large artery that supplies the lateral surface of the cerebral hemisphere
b. Thrombus that has formed on a ruptured atheromatous plaque located at the bifurcation of the common carotid	b. Thrombus that has formed on a ruptured atheromatous plaque located at the bifurcation of the common carotid
c. Rupture of a small penetrating artery that supplies deep interior structures of the brain	c. Rupture of a small penetrating artery that supplies deep interior structures of the brain
d. Reduction of cardiac output due to myocardial infarction, with resulting decrease in cerebral blood flow	d. Reduction of cardiac output due to myocardial infarction, with resulting decrease in cerebral blood flow

Which one of the following statements about stroke is false?

Your Answer	Correct Answer
a. Ischemic strokes are more common than hemorrhagic strokes	a. Ischemic strokes are more common than hemorrhagic strokes
b. Hemorrhagic strokes usually involve large arteries, while ischemic strokes involve only small arteries	b. Hemorrhagic strokes usually involve large arteries, while ischemic strokes involve only small arteries
c. Ischemic strokes may be preceded by brief TIAs, whereas hemorrhagic strokes are not	c. Ischemic strokes may be preceded by brief TIAs, whereas hemorrhagic strokes are not
d. Hypertension increases an individual's risk of both hemorrhagic and ischemic stroke	d. Hypertension increases an individual's risk of both hemorrhagic and ischemic stroke
e. Ischemic strokes may be caused by embolization of thrombus from diseased cerebral arteries or the heart	e. Ischemic strokes may be caused by embolization of thrombus from diseased cerebral arteries or the heart

What lobes of the brain have been infarcted in this specimen?

Your Answer	We Were Looking For:
	Frontal, parietal, temporal - maybe a little occipital.

This CT scan (no contrast) was done in the emergency department about 2 hours after the patient experienced the sudden onset of left-sided paralysis and sensory loss. Does the area of hyperdensity ("white" area) represent:

Your Answer	Correct Answer
a. hemorrhage	a. hemorrhage
b. ischemic tissue	b. ischemic tissue

End of Self Test
Module 1