Ischemic stroke

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Ischemic stroke



Ischemic stroke


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USMLE® Step 1 questions

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High Yield Notes

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Ischemic stroke

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USMLE® Step 1 style questions USMLE

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A 78-year-old right-handed man is brought to the emergency department following sudden-onset weakness in his right arm and inability to speak for twenty four hours. The patient’s daughter states she initially became concerned when he dropped his cup of coffee while walking to the kitchen table last night. The daughter states he has had a similar episode in the past that resolved spontaneously. He has a history of hypertension, for which he takes lisinopril. His temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 158/104 mmHg. The patient is alert and visibly frustrated by not being able to speak. Physical examination reveals 2/5 strength in the right upper extremity and 4/5 strength in the right lower extremity. He follows written and verbal commands but is unable to speak or write. MRI of the head demonstrates ischemic changes in the cerebral territory supplied by the left middle cerebral artery. Which of the following histopathological findings are most likely to be observed in this patient’s brain at the present time?

External References

First Aid








Aspirin p. 499

for ischemic stroke p. 529

Atrial fibrillation

embolic stroke p. 529

Clopidogrel p. 445

for ischemic stroke p. 529

Deep venous thrombosis (DVT) p. 697

embolic stroke and p. 529

Embolic stroke p. 529

Thrombotic stroke p. 529

Tissue plasminogen activator (tPA)

for ischemic stroke p. 529


Content Reviewers

There are two main types of stroke: an ischemic stroke which is when there’s a blocked artery that reduces blood flow to the brain and a hemorrhagic stroke which is when an artery in the brain breaks, creating a pool of blood that damages the brain.

Of the two, ischemic strokes are much more common, and the amount of damage they cause is related to the parts of the brain that are affected and how long the brain suffers from reduced blood flow.

Now if symptoms self-resolve within 24 hours, it’s called a transient ischemic attack and there are usually minimal long-term problems.

OK - let’s start with some basic brain anatomy. The brain has a few regions - the most obvious is the cerebrum, which is divided into two cerebral hemispheres, each of which has a cortex - an outer region - divided into four lobes including the frontal lobe, parietal lobe, temporal lobe, and the occipital lobe.

There are also a number of additional structures - including the cerebellum, which is down below, as well as the brainstem which connects to the spinal cord.

The right cerebrum controls muscles on the left side of your body and vice versa.

The frontal lobe controls movement, and executive function, which is our ability to make decisions.

The parietal lobe processes sensory information, which lets us locate exactly where we are physically and guides movements in a three dimensional space.

The temporal lobe plays a role in hearing, smell, and memory, as well as visual recognition of faces and languages.

Finally there’s the occipital lobe which is primarily responsible for vision.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Stroke" The Lancet (2008)
  6. "Spontaneous intracerebral haemorrhage" BMJ (2009)

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