A 72-year-old man with a 10-year history of hypertension presents to the emergency department with a generalized tonic-clonic seizure. His wife reports he suffered an acute ischemic stroke 8 days ago affecting the left motor cortex, which caused transient right-sided weakness that has since mostly resolved. On examination, the seizure originated with focal jerking of the right hand before generalizing. Vital signs: BP 162/94 mmHg, HR 102 bpm, RR 18/min, Temperature 37.1°C, SpO2 99% on room air. CT head shows hypodensity in the left motor cortex consistent with subacute infarction without hemorrhage. Which of the following mechanisms best explains why this patient developed a seizure in the early post-stroke period?
- A)Cortical gliosis and scar formation around the infarct creating chronic irritable foci
- B)Acute ischemic injury with ionic imbalance (K+ release, Ca2+ influx) and glutamate excitotoxicityGABARITO
- C)Hemorrhagic transformation of the ischemic stroke with blood breakdown products
- D)Elevated blood pressure during acute stroke phase directly triggering seizure activity
- E)Recurrent microemboli from atrial fibrillation progressively lowering seizure threshold
Explicação
Early post-stroke seizures (within 2 weeks) are primarily driven by acute ionic derangements and excitotoxicity from the ischemic injury itself. Ischemia causes energy failure, leading to loss of Na+/K+-ATPase function, resulting in intracellular K+ accumulati... Ver explicação completa e trilha adaptativa →