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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?
Explanation
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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
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Reference
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Bradleys NiCP, 7th edn, Ch. 65, pp. 920967
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Option 1
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Is Correct (Option 1):
Hypercoagulable state from neoplasm
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Option 2
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Is Correct (Option 2):
Atrial fibrillation
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Option 3
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Is Correct (Option 3):
Oral contraception pills
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Option 4
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Is Correct (Option 4):
Arterial dissection
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