A 78-year-old man is brought to the emergency department because of difficulty speaking. The symptoms began abruptly one hour ago while he was having breakfast with his wife. He has hypertension, type 2 diabetes mellitus, and coronary artery disease. Current medications include pravastatin, lisinopril, metformin, and aspirin. His temperature is 37°C (98.6°F), pulse is 76/min, and blood pressure is 165/90 mm Hg. He is right-handed. The patient speaks in short, simple sentences, and has difficulty repeating sequences of words. He can follow simple instructions. Right facial droop is present. CT scan of the brain reveals early infarction in theleft middle cerebral artery territory with no acute hemorrhage. Several hours later, he becomes progressively obtunded with elevated intracranial pressure. A repeat CT scan reveals edema in the region of acute infarction causing mass effect. Which of the following is the primary contributor to the pathogenesis of this patient's raised intracranial pressure?

Question

A 78-year-old man is brought to the emergency department because of difficulty speaking. The symptoms began abruptly one hour ago while he was having breakfast with his wife. He has hypertension, type 2 diabetes mellitus, and coronary artery disease. Current medications include pravastatin, lisinopril, metformin, and aspirin. His temperature is 37°C (98.6°F), pulse is 76/min, and blood pressure is 165/90 mm Hg. He is right-handed. The patient speaks in short, simple sentences, and has difficulty repeating sequences of words. He can follow simple instructions. Right facial droop is present. CT scan of the brain reveals early infarction in theleft middle cerebral artery territory with no acute hemorrhage. Several hours later, he becomes progressively obtunded with elevated intracranial pressure.  A repeat CT scan reveals edema in the region of acute infarction causing mass effect.  Which of the following is the primary contributor to the pathogenesis of this patient's raised intracranial pressure?

Quizplus · Accepted Answer

Eductional Objective: The primary mechanism underlying cytotoxic (early) edema following cerebral ischemia is the accumulation of intracellular Na⁺ and water due to the failure of ATP-dependent ion transporters in hypoxic cells. Cerebral edema causes progressive neurologic decline by raising intracranial pressure, which can directly damage neural tissue or result in mechanical damage due to brain herniation.

A 78-Year-Old Man Is Brought to the Emergency Department Because