Complete Answers Emergency Medicine Neurology Guide 2023 / 2024 (Brand New!!) TB Guide All Q&As Included!! A++

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1) A woman presents with 30 minutes of double vision, vertigo, difficul- ty swallowing, and difficulty speaking. During her initial evaluation, these symptoms resolve and her neurologic exam returns... to normal.Which of the following is the most appropriate diagnosis and the most likely affected artery? Embolic ischemia - anterior cerebral artery Thrombotic stroke - left anterior descending artery Transient ischemic attack - middle cerebral artery Transient ischemic attack - vertebrobasilar arteries Answer ( D ) Explanation: Transient ischemic attacks (TIAs) are characterized by an abrupt onset of focal neurologic symptoms lasting less than 24 hours and often lasting only five to 20 minutes. TIAs suggest impending thrombotic-ischemic stroke. Carotid pathology leads to TIAs demonstrated by hemiparesis, hemisensory, aphasia, confusion andtransient monocular blindness. Vertebrobasilar insufficiency leads to TIAs markedby hemiplegia or quadriplegia, varying sensory changes, blindness, hemianopsia,diplopia, vertigo, dysarthria, dysphagia and facial, motor, and sensory change. Investigation includes Doppler ultrasonography of the carotids and vertebrobasilarsystem. Head CT scan will not show any acute changes. MRA angiography may also be indicated. Selected cases may require endarterectomy, angioplasty or lifelong anticoagulation. Embolic ischemia typically produces symptoms that last longer than three hoursand anterior cerebral artery (A) lesions do not produce vertigo and diplopia. Thrombotic stroke (B) indicates infarct, which indicates permanent, not temporaryor resolved, neurologic defect. Middle cerebral artery (C) lesions do not produce vertigo. [Show More]

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