An 18-year-old with severe hypertension and altered consciousness after internet diet pills is most likely to have which complication?

• A. Hypertensive encephalopathy
• B. Ischemic stroke
• C. Myocardial infarction
• D. Hemorrhagic stroke

Answer: (D)

When someone has a sudden, severe spike in blood pressure from stimulant-containing diet pills, the brain’s small penetrating arteries are high risk for rupture. This leads to bleeding into the brain tissue itself, a hemorrhagic stroke. In young patients, this kind of intracerebral hemorrhage often presents with rapid deterioration in consciousness, and can occur in deep structures like the basal ganglia or thalamus due to the vasosruptive effect of the hypertension.

Hypertensive encephalopathy can also cause altered mental status, but it is more about diffuse brain dysfunction from widespread edema and not the focal bleeding seen with a hemorrhagic stroke. Ischemic stroke would arise from a blockage and tends to present with abrupt focal deficits rather than rapid deterioration from a hemorrhage. Myocardial infarction presents with chest symptoms, not primarily neurologic changes.