UW path Q Id 22[621802]

[MudPhud20XX]

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A 58 yr old man comes to the emergency dept due to sudden right-sided weakness. He has no sensory loss, problems speaking/swallowing, or difficulty with balance. The pt was previously told that he has elevated blood pressure but does not routinely follow up with his physician. His mother has coronary artery dz, and his father died of stroke. He takes no medications. Exam shows intact cranial nerves and sensory function. The patient has decreased strength (3/5) on his right side. Initial CT scan w/o contrast shows no abnormalities. Four weeks later, repeat brain imaging shows a 9 mm, lakelike cavitary lesion in the Lt. internal capsule. This pt's condition is most likely caused by which of the following?

A. Charcot-Bouchard aneurysm
B. Hypertensive arteriolar sclerosis

 

[tasar1898]

Typical lacunar stroke in internal capsule, its B

 

[MudPhud20XX]

Why not A?

 

[Reperfused]

Charcot Bouchard aneurysm causes hemorrhagic infarct, which would have shown up on the initial CT.

Hypertensive arteriolar sclerosis leads to ischemic infarct which can eventually show up as cavitatory lesions.

By the way, Robbins mentions the exact terminology of "lake-like lesions" for this in the internal capsule! OMG, does that mean we'll have to open robbins in order to master these UWorld questions Help!

 

[tasar1898]

I didn't read a single page of Robbins , it's just a typical small ischemic... @MudPhud20XX no way you can confuse hemorrhages with a simple ischemic stroke.. The clinical picture for small ischemics is like the one in the Uworld q , while a hemorrhagic one is much more noisy , the pt may look super drunk , then quickly slips into coma if the hematoma is large , and the neurologic deficits are usually multiple

 

[Reperfused]

Yeah I agree, my knowledge based on pathoma was enough to solve this question.
But for a moment I got scared when I saw reference from robbins (in an older thread on SDN) mentioned exact "lake-like cavitatory lesions" just like in the question. This typical description is not in pathoma or first aid.