NEUROLOGY
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Global Burden of Neurological Disease — Introduction
Stem
A regional stroke registry in a low-resource coastal community
reports a sudden rise in ischemic strokes during an extended
heatwave. A 68-year-old man presents with sudden right
hemiparesis and aphasia on day 4 of the heatwave; he is
Page | 1
,dehydrated and taking a thiazide diuretic. Early CT shows no
hemorrhage. Which population-level factor best explains the
transient increase in ischemic strokes during heatwaves?
Options
A. Increased prevalence of cardioembolic sources due to viral
myocarditis.
B. Heat-related hemoconcentration and dehydration increasing
thrombosis risk.
C. Increased air pollution particulate count causing immediate
large-artery atherosclerotic plaque rupture.
D. Temperature-induced autoimmune activation causing
cerebral vasculitis.
Correct answer
B
Rationale — Correct (B)
Heatwaves cause dehydration and hemoconcentration, raising
blood viscosity and promoting thrombosis — mechanisms
highlighted in Queen Square’s discussion of environmental
triggers for vascular events. In elderly patients on diuretics this
Page | 2
,effect is amplified, increasing ischemic stroke incidence. This
explains a transient community-level rise during heat extremes.
Rationale — Incorrect
A. Viral myocarditis is not seasonally tied to heatwaves and
would not explain a rapid population spike.
C. Air pollution can increase stroke risk but acute clotting from
hemoconcentration explains the temporal association with heat
better.
D. Autoimmune cerebral vasculitis is uncommon and unlikely to
produce a rapid community-wide surge.
Teaching Point
Heat-related dehydration raises hemoconcentration and
thrombosis risk, increasing ischemic stroke incidence.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
2
Page | 3
, Reference
Ch. 1 — Neurology and Global Warming — Vector-borne
Neuroinfections
Stem
During an unusually mild winter and early spring, a rural region
records more cases of febrile meningoencephalitis. A 52-year-
old farmer presents with fever, confusion, tremor, and
asymmetric limb weakness. CSF shows lymphocytic pleocytosis
and elevated protein. Considering climate-driven vector range
shifts, which pathogen is most consistent with new regional
emergence causing such presentations?
Options
A. Enteroviral meningitis transmitted by fecal–oral spread.
B. West Nile virus transmitted by Culex mosquitoes.
C. Neurosyphilis from chronic Treponema pallidum infection.
D. Herpes simplex virus type 1 reactivation.
Correct answer
B
Page | 4
A QUEEN SQUARE TEXTBOOK
3RD EDITION
• AUTHOR(S)ROBIN HOWARD
TEST BANK
1
Reference
Ch. 1 — Global Burden of Neurological Disease — Introduction
Stem
A regional stroke registry in a low-resource coastal community
reports a sudden rise in ischemic strokes during an extended
heatwave. A 68-year-old man presents with sudden right
hemiparesis and aphasia on day 4 of the heatwave; he is
Page | 1
,dehydrated and taking a thiazide diuretic. Early CT shows no
hemorrhage. Which population-level factor best explains the
transient increase in ischemic strokes during heatwaves?
Options
A. Increased prevalence of cardioembolic sources due to viral
myocarditis.
B. Heat-related hemoconcentration and dehydration increasing
thrombosis risk.
C. Increased air pollution particulate count causing immediate
large-artery atherosclerotic plaque rupture.
D. Temperature-induced autoimmune activation causing
cerebral vasculitis.
Correct answer
B
Rationale — Correct (B)
Heatwaves cause dehydration and hemoconcentration, raising
blood viscosity and promoting thrombosis — mechanisms
highlighted in Queen Square’s discussion of environmental
triggers for vascular events. In elderly patients on diuretics this
Page | 2
,effect is amplified, increasing ischemic stroke incidence. This
explains a transient community-level rise during heat extremes.
Rationale — Incorrect
A. Viral myocarditis is not seasonally tied to heatwaves and
would not explain a rapid population spike.
C. Air pollution can increase stroke risk but acute clotting from
hemoconcentration explains the temporal association with heat
better.
D. Autoimmune cerebral vasculitis is uncommon and unlikely to
produce a rapid community-wide surge.
Teaching Point
Heat-related dehydration raises hemoconcentration and
thrombosis risk, increasing ischemic stroke incidence.
Citation
Howard, R. (2021). Neurology: A Queen Square Textbook (3rd
ed.). Ch. 1.
2
Page | 3
, Reference
Ch. 1 — Neurology and Global Warming — Vector-borne
Neuroinfections
Stem
During an unusually mild winter and early spring, a rural region
records more cases of febrile meningoencephalitis. A 52-year-
old farmer presents with fever, confusion, tremor, and
asymmetric limb weakness. CSF shows lymphocytic pleocytosis
and elevated protein. Considering climate-driven vector range
shifts, which pathogen is most consistent with new regional
emergence causing such presentations?
Options
A. Enteroviral meningitis transmitted by fecal–oral spread.
B. West Nile virus transmitted by Culex mosquitoes.
C. Neurosyphilis from chronic Treponema pallidum infection.
D. Herpes simplex virus type 1 reactivation.
Correct answer
B
Page | 4
