Part 1: Ischemic Stroke: Pathophysiology and Principles of Localization

Matthew Brandon Maas, MD, and Joseph E. Safdieh, MD

Dr. Maas is a fellow in Stroke and Neurocritical Care, Harvard Medical School, Departments of Neurology, Massachusetts General and Brigham and Women’s Hospitals, Boston, MA. Dr. Safdieh is an assistant professor of neurology, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY.

Question 4

Questions 4 and 5 refer to the following case.
A 38-year-old man presents to the emergency department complaining of an episode of left arm heaviness and clumsiness that lasted for approximately 5 minutes. The patient is no longer concerned about the event. However, he explains that he has not felt well for the past 2 days and stayed awake with chills the night before. He is sure the event was caused by being tired. The neurologic examination is normal. The general examination is notable for a mild heart murmur, which the patient states has been present since childhood, and some scarring on the forearms and antecubital areas. The patient reports no family history of neurologic disease.
Based on the information presented, which mechanism of cerebral ischemia appears to be most plausible?

  •  Cardioembolism
  •  Cerebral autosomal dominant arteriopathy with subcortical infarcts and
    leukoencephalopathy (CADASIL)
  •  Cerebral vasculitis
  •  Lipohyalinosis
  •  Mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes (MELAS)

Updated 12/03/2014 • jdw | Copyright ©2018 Turner White Communications