A 73-year-old man arrives at the emergency room with right-sided weakness and difficulty speaking. The patient had the symptoms an hour before arriving but felt fine when he went to bed the night before. He has a history of paroxysmal atrial fibrillation but does not follow medical treatment. The temperature is 98.6 degrees Fahrenheit (37 degrees Celsius), the blood pressure is 130/70 mm Hg, and the pulse rate is 110 beats per minute and irregular. A right-sided hemiplegia, hemisensory loss, and aphasia are discovered during a physical examination. Despite adequate treatment, the patient's symptoms do not improve. Over the next week, which of the following processes is most likely to occur in the affected brain region?

Question

Quizplus · Accepted Answer

Eductional Objective: The symptoms of this patient point to an ischemic stroke involving the left middle cerebral artery territory. Given his history of atrial fibrillation and the lack of anticoagulation therapy, an embolism is the most likely cause. The irreversible neural cell injury that results causes immune cell migration and hydrolytic enzyme release, resulting in necrosis of damaged neural tissue. Although ischemic cell death causes coagulative necrosis in most organs, it causes liquefactive necrosis in the brain within 10 days of the infarction due to the brain's lack of supporting architecture.
Over the next few months to years, the infarcted CNS tissue is digested by microglia and replaced with a cystic space surrounded by a dense astroglial scar (gliosis).

A 73-Year-Old Man Arrives at the Emergency Room with Right-Sided