Pre-Quiz: Hemorrhagic Stroke

A 62-year-old male patient with a history of coronary artery disease is being assessed in the ER for an operable intracerebral hemorrhage. He is currently on aspirin and clopidogrel for therapeutic management of his cardiac condition. Prior to performing the procedure, his antiplatelet therapy has to be reversed; hence, desmopressin is the chosen agent for this case.

How does desmopressin function to counteract the effects of antiplatelet medications?

A 50-year-old woman presents to the emergency department exhibiting severe headache, neck stiffness, and photophobia. Her blood pressure is recorded at 155/95 mmHg and pulse at 85 beats per minute. Due to suspicion of subarachnoid hemorrhage, a lumbar puncture is performed. Given the possibility of a traumatic lumbar puncture, which of the following cerebrospinal fluid (CSF) findings is most instrumental for differentiating a subarachnoid hemorrhage (SAH) from a traumatic lumbar puncture (LP)?

A 77-year-old male with a history of chronic kidney disease and atrial fibrillation, who is not on any regular medications, presents to the emergency department with sudden onset headache, vomiting, and decreased consciousness. He is subsequently diagnosed with a primary intracranial hemorrhage (ICH). The following laboratory data is available: serum creatinine 2.2 mg/dL, INR 2.9. His vital signs are as follows: heart rate 64 per minute, blood pressure 210/118 mmHg, temperature 98F, respiratory rate 16 per minute, and he is mechanically ventilated on 60% FiO2.

In patients with spontaneous ICH, rapid reduction of drastically elevated blood pressure is crucial to prevent further bleeding and to mitigate secondary brain injury. In this context, to minimize the risk of impaired cerebral perfusion, the therapeutic goal is to lower systolic blood pressure to approximately 160 mmHg over a relatively short duration.

Following this guideline, the team administers a specific antihypertensive agent, which successfully brings down the systolic pressure to the desired range swiftly. Which of the following agents is most likely to have been administered, and why?

Mrs. IL, a 45-year-old woman, arrives at the emergency department reporting severe pain in the back of her head and neck. She describes it as the “worst headache of her life.” Her medical history includes noncompliance with hypertension treatment and past cigarette use. Initial vital signs are: BP 187/98 mmHg, HR 103 bpm, SpO2 99% on room air, and respiratory rate 22 breaths/minute. Given her symptoms, which of the following would be the ideal blood pressure target for this patient?

A 45-year-old male is rushed into the emergency department after a severe motor vehicle accident. On examination, he appears unconscious with significant signs of a head trauma. His vitals include a blood pressure of 190/110 mmHg, a pulse rate of 52 bpm, and an irregular respiration. Based on these symptoms, which of the following would NOT be considered a part of Cushing’s Triad?