American Board of Internal Medicine (ABIM) Certification Practice Exam

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What condition can be detected on a noncontrast CT scan of the head following thrombolysis for ischemic stroke?

Ischemic changes
Hemorrhage
Edema
Infarction

The correct answer is: Hemorrhage

Following thrombolysis for ischemic stroke, a noncontrast CT scan of the head can be particularly useful in assessing for potential complications, one of which is hemorrhage. Thrombolytic therapy, while beneficial in dissolving the clot causing the ischemic stroke, carries the risk of causing bleeding, especially in the affected brain area. In the context of a noncontrast CT scan, any new hyperdense areas may indicate the presence of hemorrhage, which could appear as a focal or diffuse radiopaque area within the brain. Detecting hemorrhage is critical, as it can influence management decisions, including the potential need to reverse the thrombolytic agent or provide additional interventions. While ischemic changes, edema, and infarction may also be noted on imaging, the acute identification of hemorrhage immediately following thrombolysis is a significant concern in the management of stroke patients, making it a key focus for radiological evaluation. This detail emphasizes the importance of monitoring patients closely after thrombolysis to identify any complications promptly.