Cerebrovascular Disease USMLE Step 1 Practice Question
A 34-year-old woman without prior medical history presents to the emergency department 6 hours after acute onset of left-sided hemiparesis and expressive aphasia. She delivered via emergency cesarean section 4 days ago for arrest of dilation. Vital signs: BP 142/88 mmHg, HR 92, RR 18, temp 37.5°C, SpO2 97% on room air. Neurologic examination confirms left facial droop and arm drift. CT angiography of the head and neck reveals acute ischemic stroke in the right middle cerebral artery territory. Noncontrast head CT shows no hemorrhage. Cardiac examination is unremarkable with regular rate and rhythm. Echocardiography shows normal ejection fraction without evidence of thrombus. Which of the following is the most likely etiology of this patient's stroke?
Answer choices
- ACervical artery dissection (carotid or vertebral)Correct answer
- BPeripartum cardiomyopathy with cardioemboli
- CCerebral venous sinus thrombosis
- DParadoxical embolism from occult patent foramen ovale
- EThrombosis secondary to antiphospholipid syndrome
- FAtherosclerotic intracranial large vessel disease
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