Neurology: Case of the Month

Test Yourself — Patient 61

Exacerbation of stroke deficit, with adenocarcinoma of the right colon

1. Symptomatic exacerbation of remote stroke deficits may be caused by
   • [ A ] pneumonia
   • [ B ] urinary tract infection
   • [ C ] anemia
   • [ D ] volume overload
   • [ E ] all of the above
2. Based on studies of anesthetic agents in patients with remote cerebral insults, symptomatically recovered brain tissue is vulnerable to inhibition of which receptor type
   • [ A ] NMDA
   • [ B ] GABAA
   • [ C ] GABAB
   • [ D ] 5-HT1A
   • [ E ] D2
3. Proinflammatory cytokines may be responsible for which of the following?
   • [ A ] reversible alteration of neuronal function
   • [ B ] invasion of inflammatory cells from the periphery to the CNS
   • [ C ] direct injury of neurons
   • [ D ] all of the above
4. Which of the following statements about stroke associated with anemia are FALSE?
   • [ A ] Systemic physiologic responses to anemia (such as tachycardia) invariably precede impairment of brain function.
   • [ B ] The cause of anemia may predispose to stroke.
   • [ C ] Anemia may precipitate recurrent symptoms in previously compromised brain.
   • [ D ] Transfusion may be used to treat focal CNS dysfunction associated with anemia.
5. Which of the following statements about symptomatic anemia are TRUE?
   • [ A ] Anemia is only rarely associated with a hypercoagulable state.
   • [ B ] Subacute blood loss may predispose to cerebral dysfunction, but usually spares the heart.
   • [ C ] An elevated reticulocyte count is seen with hemolysis, but rarely with gastrointestinal blood loss.
   • [ D ] Malignancy need not involve the bone marrow to produce significant anemia.
   • [ E ] Choices B and D are both true.

 

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