A 34-year-old woman without prior medical history presents to the emergency department 6 hours after acute onset of left-sided hemiparesis and expressive aphasia. She delivered via emergency cesarean section 4 days ago for arrest of dilation. Vital signs: BP 142/88 mmHg, HR 92, RR 18, temp 37.5°C, SpO2 97% on room air. Neurologic examination confirms left facial droop and arm drift. CT angiography of the head and neck reveals acute ischemic stroke in the right middle cerebral artery territory. Noncontrast head CT shows no hemorrhage. Cardiac examination is unremarkable with regular rate and rhythm. Echocardiography shows normal ejection fraction without evidence of thrombus. Which of the following is the most likely etiology of this patient's stroke?
- A)Cervical artery dissection (carotid or vertebral)GABARITO
- B)Peripartum cardiomyopathy with cardioemboli
- C)Cerebral venous sinus thrombosis
- D)Paradoxical embolism from occult patent foramen ovale
- E)Thrombosis secondary to antiphospholipid syndrome
Explicação
Cervical artery dissection (both carotid and vertebral) is the leading cause of ischemic stroke in young women, particularly in the peripartum period. The postpartum state carries increased risk due to hemodynamic changes, hormonal shifts, and connective tissu... Ver explicação completa e trilha adaptativa →