A 67-year-old develops a painful partial Horner syndrome after sudden unilateral neck pain while exercising. Diffusion-weighted MRI shows small

Question

A 67-year-old develops a painful partial Horner syndrome after sudden unilateral neck pain while exercising. Diffusion-weighted MRI shows small ipsilateral cortical embolic infarcts and CTA demonstrates tapering of the cervical internal carotid artery consistent with dissection. What antithrombotic approach is most appropriate initially?

Accepted Answer

Use either antiplatelet therapy or anticoagulation after individual bleeding-risk assessment

Answer

Use indefinite dual antiplatelet therapy because dissection always requires two agents

Answer

Use no antithrombotic therapy because dissection-related infarcts cannot recur

Answer

Use carotid endarterectomy as routine first-line treatment for all dissections

Answer

Use thrombolysis beyond the standard window because the mechanism is non-atherosclerotic

Carotid Endarterectomy – Timing — SCE Neurology MCQ