Stroke and Cognitive Change — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryStroke and Cognitive ChangeMRCPsych Paper B

A 70-year-old man with no previous cognitive impairment develops sudden disorientation, right-sided weakness and difficulty producing speech. CT brain confirms a left cerebral infarct. What is the most likely cause of his acute cognitive change?

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Correct answer: C — Acute ischaemic stroke

The correct answer is C: acute ischaemic stroke. The abrupt onset, contralateral weakness and expressive language difficulty localise to the left cerebral hemisphere, and CT confirms an infarct. Stroke can produce immediate cognitive impairment, including disorientation, impaired attention and executive dysfunction. Delirium may coexist with or be precipitated by an acute stroke, but a systemic cause of delirium would not explain the focal neurological deficits and corresponding infarct. Alzheimer's disease and dementia with Lewy bodies usually produce progressive cognitive syndromes rather than a sudden focal presentation. Normal-pressure hydrocephalus is also insidious and classically presents with gait impairment, cognitive decline and urinary symptoms.

Reference: National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128), sections 1.1 and 1.3. 2019, updated 2022. https://www.nice.org.uk/guidance/ng128/chapter/Recommendations