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Carotid dissection — SCE Neurology MCQ

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HardStrokeCarotid dissectionSCE Neurology

A 71-year-old with known right internal-carotid occlusion has recurrent 30-second episodes of left-arm jerking when he stands or walks after meals. The face is spared, awareness is retained, there is no Jacksonian march and symptoms stop on sitting. Which mechanism best explains the attacks?

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Correct answer: A — Haemodynamic hemispheric hypoperfusion producing limb-shaking TIAs

Explanation lettering: C = shown as A · E = shown as C · A = shown as E

A remains possible in other settings, but the postural trigger, face sparing, absent march and immediate relief with sitting favour haemodynamic events. B affects the legs while standing and does not cause unilateral arm attacks. C is correct: limb-shaking TIA signals severe carotid or middle-cerebral haemodynamic compromise. D produces stereotyped lacunar deficits rather than jerking. E usually begins much younger and is triggered by sudden movement rather than reduced perfusion.

Reference: Transient ischaemic attacks: mimics and chameleons: https://pn.bmj.com/content/14/1/23