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Neurology — SCE Neurology MCQ

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HardB). No therapy is unsafe (E)."NeurologySCE Neurology

A patient has repeated stereotyped episodes of face, arm and leg weakness lasting several minutes over 24 hours, without cortical features. MRI shows a small acute internal-capsule infarct and vascular imaging shows no treatable large-vessel lesion. What is the safest disposition?

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Correct answer: B — Monitored stroke-unit admission for capsular warning syndrome

The best answer is “Monitored stroke-unit admission for capsular warning syndrome”. A capsular warning syndrome reflects recurrent perforator-territory ischaemia and carries a substantial early risk of completed stroke; specialist-unit admission permits rapid reassessment, physiological optimisation and evidence-based antithrombotic prevention. “Outpatient review after transient resolution of all lacunar symptoms” is less appropriate because transient recovery does not remove the high early recurrence risk “Therapeutic heparin for recurrent perforator-territory ischaemia” is less appropriate because fluctuation alone is not an indication for full-dose heparin “Functional-neurology referral for stereotyped pure-motor episodes” is less appropriate because stereotyped lacunar episodes with an acute capsular lesion are positive vascular evidence “Delayed outpatient MRI after six months of symptom surveillance” is less appropriate because delayed imaging and prevention miss the period of greatest risk

Reference: NICE NG128: Stroke and transient ischaemic attack in over 16s. https://www.nice.org.uk/guidance/ng128/chapter/recommendations