TIA with carotid stenosis — SCE Neurology MCQ

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HardStrokeTIA with carotid stenosisSCE Neurology

A 32-year-old with a recent neck injury develops painful partial Horner syndrome followed by a small ipsilateral hemispheric infarct. CTA shows a long tapered narrowing of the extracranial internal carotid artery without atherosclerotic stenosis. What diagnosis best explains the presentation?

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Correct answer: E — Internal-carotid artery dissection

The best answer is “Internal-carotid artery dissection”. Neck pain, partial Horner syndrome and ipsilateral cerebral ischaemia with a tapered extracranial carotid lesion form the classic dissection syndrome; the sympathetic fibres run alongside the artery and embolism causes stroke. “Giant-cell arteritis” is less appropriate because GCA is unlikely at this age and does not characteristically create this trauma-linked tapered lesion “Cerebral venous sinus thrombosis” is less appropriate because venous thrombosis produces a different vascular territory and imaging abnormality “Carotid body tumour” is less appropriate because a carotid body mass does not produce a long mural narrowing with infarction “Primary lateral medullary degeneration” is less appropriate because a degenerative medullary process does not explain the arterial imaging

Reference: NICE NG128: Stroke and transient ischaemic attack in over 16s. https://www.nice.org.uk/guidance/ng128/chapter/recommendations