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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 74 OF 100
A right-handed, 26-year-old woman presents with an acute onset of right gaze deviation, left-sided weakness, left facial droop, and right-sided visual and sensory neglect. Her husband reports she has no medical problems but has had neck pain following a motor vehicle crash 4 days ago. Which of the following is the most likely etiology of her stroke given the history?
A. Cardioembolic from left ventricular thrombus
B. Infective endocarditis with embolism
C. Cervical carotid artery dissection with in situ thrombus formation and embolization **
D. Underlying paroxysmal atrial fibrillation
E. Small vessel disease with lacunar infarct
** = Your answer
Given the history of a recent motor vehicle crash and subsequent anterior neck pain (likely carotidynia), traumatic cervical carotid artery dissection is the most likely etiology. The patient’s stroke syndrome seems to fit a carotid artery distribution, specifically the right middle cerebral artery.
* Pozzati E, Giuliani G, Poppi M, et al. Blunt traumatic carotid dissection with delayed symptoms. Stroke. 1989 Mar;20(3):412-416.