A 65-Year-Old Man Comes to the Emergency Department with Right

A 65-year-old man comes to the emergency department with right upper and lower extremity weakness and slurred speech.  The patient went to bed in his usual state of health and woke up with these symptoms.  His medical problems include type 2 diabetes mellitus, hypertension, and hyperlipidemia.  He takes atorvastatin, metformin, lisinopril, and low-dose aspirin.  The patient has smoked a pack of cigarettes daily for the past 40 years.  His temperature is 36.7 C (98 F) , blood pressure is 160/90 mm Hg, and pulse is 118/min.  He is mildly dysarthric with a right lower facial droop and right-sided hemiparesis.  A noncontrast head CT is normal.  Brain MRI reveals an acute subcortical infarct in the left internal capsule.  Six months later, which of the following findings is most likely to be observed in the affected pyramidal tracts of this patient?

A) Calcification
B) Cytotoxic edema
C) Eosinophilic neurons
D) Hemorrhagic transformation
E) Neutrophilic infiltration
F) Persistent myelin debris
G) Vasogenic edema

Correct Answer:

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