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?

  1. A)Cortical gliosis and scar formation around the infarct creating chronic irritable foci
  2. B)Acute ischemic injury with ionic imbalance (K+ release, Ca2+ influx) and glutamate excitotoxicityGABARITO
  3. C)Hemorrhagic transformation of the ischemic stroke with blood breakdown products
  4. D)Elevated blood pressure during acute stroke phase directly triggering seizure activity
  5. 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 →

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