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Vertebral artery dissection — SCE Neurology MCQ

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ModerateStrokeVertebral artery dissectionSCE Neurology

A 22-year-old man presented with occipital headache after neck manipulation followed by diplopia and ataxia. On examination, there was nystagmus, dysarthria and crossed sensory loss. Initial investigations showed: CTA showed irregular narrowing of the V3 vertebral artery segment. What is the most likely diagnosis?

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Correct answer: E — Vertebral artery dissection

Vertebral artery dissection is the best answer because the vignette describes Vertebral artery dissection: posterior circulation symptoms after neck trauma suggest vertebral dissection. Reversible cerebral vasoconstriction syndrome is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Watershed infarction and Intracerebral haemorrhage are less appropriate because they would require different localisation, timing or test findings; Locked-in syndrome would fit a different syndrome. Clinical pearl: benign positional vertigo lacks crossed signs and vascular imaging abnormality.

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