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Question 2

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

Answer to Question 2

Correct Answer:

c. Rupture of a small penetrating artery that supplies deep interior structures of the brain

Additional Information:

This is a large intracerebral hemorrhage. In this case, we believe that bleeding involved a small penetrating artery vessel supplying the putamen (one of the basal ganglia). At least half of all patients who have this kind of hemorrhage have a history of hypertension.