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Posterior circulation stroke — SCE Neurology MCQ

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ModerateStrokePosterior circulation strokeSCE Neurology

A 36-year-old woman presented with acute vertigo, vomiting, diplopia and unsteadiness. On examination, there was direction-changing nystagmus, dysarthria and right limb ataxia. Initial investigations showed: CT head was normal; MRI diffusion imaging showed right lateral medullary infarction. Where is the most likely anatomical localisation?

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Correct answer: D — right lateral medulla

right lateral medulla is the best answer because the vignette describes Posterior circulation stroke: brainstem signs with ataxia indicate posterior circulation stroke despite normal CT. Superior sagittal sinus is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Subarachnoid space and Basal ganglia nigrostriatal pathway are less appropriate because they would require different localisation, timing or test findings; Thalamus would fit a different syndrome. Clinical pearl: vestibular neuritis should not cause dysarthria or long-tract signs.

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