Malignant MCA Infarction – Herniation — SCE Neurology MCQ

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HardCerebrovascular DiseaseMalignant MCA Infarction – HerniationSCE Neurology

A 65-year-old man with large right MCA stroke develops progressive drowsiness at 36 hours with right pupil dilation and left extensor posturing. CT shows massive oedema with 10 mm midline shift. What complication has occurred?

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Correct answer: C — Malignant MCA infarction with uncal herniation

The best answer is “Malignant MCA infarction with uncal herniation”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Haemorrhagic transformation, within the relevant UK pathway”, “Recurrent stroke, after excluding important mimics”, “Seizure, after specialist assessment”, “Metabolic encephalopathy, when the phenotype supports it” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/