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Question Date: 02/02/2024

Question: 2 A 33-year-old previously healthy woman has an acute onset of neck pain, headache, and decreased vision on the right field. She also complains of heaviness in her right arm and difficulty speaking. Her examination shows nonfluent aphasia, a right homonymous hemianopsia, and right hemiparesis. Magnetic resonance imaging confirms the suspected etiology of her symptoms, from which a key T1 fat-saturated image is shown. Otherwise, workup is negative. What isthe most likely etiology of her condition?

Options:

Hypercoagulable state from neoplasm
Atrial fibrillation
Oral contraception pills
Arterial dissection

Correct Answer: Arterial dissection

View Image: Image_2024013009333365b8c26daca60.jpg

Explaination: The etiology of her acute stroke is most likely an arterial dissection, as shown in the image. The axial image shows an intramural hematoma along the left internal carotid artery (crescent sign). Usually, dissections present with pain followed by acute neurological deficits (in this case, referable to the left frontal region). Common history clues include chiropractic manipulation, recent trauma (football injury, motor vehicle collision, fall), roller coaster ride, or aggressive coughing. Management for extracranial dissections includes antithrombotics (antiplatelets or anticoagulation) for at least 36 months followed by a repeat vessel imaging study such as computed tomography angiogram or magnetic resonance angiogram