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PFO-associated embolic stroke — SCE Neurology MCQ

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EasyStrokePFO-associated embolic strokeSCE Neurology

A 55-year-old woman presented with cryptogenic cortical infarct in a young adult after a long-haul flight. On examination, there was no carotid disease and no atrial fibrillation on prolonged monitoring. Initial investigations showed: bubble echocardiography showed a large right-to-left shunt at rest. What is the most appropriate management?

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Correct answer: A — Urgent stroke-unit care with reperfusion and secondary prevention assessment

Urgent stroke-unit care with reperfusion and secondary prevention assessment is the best answer because the vignette describes PFO-associated embolic stroke: young cryptogenic embolic stroke with large shunt suggests PFO-related mechanism. Urgent reperfusion assessment with thrombolysis or thrombectomy pathway is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. High-dose glucocorticoids with urgent visual protection and Specialist counselling about driving and DVLA notification are less appropriate because they would require different localisation, timing or test findings; Immediate intravenous lorazepam with airway support would fit a different syndrome. Clinical pearl: small-vessel disease is unlikely with a cortical infarct and no risk factors.

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