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Atrial fibrillation-related stroke — SCE Neurology MCQ

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ModerateStrokeAtrial fibrillation-related strokeSCE Neurology

A 31-year-old man presented with acute left hemiparesis in an older patient with irregularly irregular pulse. On examination, there was neglect and left homonymous hemianopia. Initial investigations showed: CTA showed right M2 occlusion; ECG confirmed atrial fibrillation. What is the most likely diagnosis?

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Correct answer: D — Atrial fibrillation-related stroke

Atrial fibrillation-related stroke is the best answer because the vignette describes Atrial fibrillation-related stroke: cortical embolic stroke with AF is cardioembolic until proved otherwise. Locked-in syndrome is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Lacunar infarct and Transient ischaemic attack are less appropriate because they would require different localisation, timing or test findings; Watershed infarction would fit a different syndrome. Clinical pearl: carotid stenosis is less likely with right-sided embolus and AF present.

Reference: NICE NG128; National Clinical Guideline for Stroke; DVLA Assessing fitness to drive