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Posterior circulation stroke — SCE Acute Medicine MCQ

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HardNeurology and ophthalmologyPosterior circulation strokeSCE Acute Medicine

A patient with atrial fibrillation has sudden continuous vertigo, dysarthria, direction-changing nystagmus and inability to sit unsupported. Non-contrast CT is normal. What is the next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Activate the stroke pathway and obtain urgent vascular imaging

The best answer is “Activate the stroke pathway and obtain urgent vascular imaging”. This is correct because central ocular-motor findings and severe truncal ataxia indicate posterior circulation ischaemia despite a normal early CT. Time-critical reperfusion and arterial imaging assessment are required. Vestibular neuritis and BPPV do not explain the focal central signs, and outpatient delay can lose treatment opportunity.

Reference: NICE NG128 stroke and transient-ischaemic-attack recommendations: https://www.nice.org.uk/guidance/ng128/chapter/Recommendations