Cerebrovascular Disease USMLE Step 1 Practice Question
A 42-year-old woman on combined oral contraceptives presents to the emergency department with sudden-onset occipital headache followed by a focal seizure and right-sided hemiparesis. She reports no recent head trauma. Vital signs: BP 148/92 mmHg, HR 102/min, RR 18/min, temperature 37.2°C, SpO2 98% on room air. Neurologic examination confirms right hemiparesis and hyperreflexia. Non-contrast head CT is unremarkable. Subsequent MRI with MRV shows a serpentine hypointense signal on T1-weighted imaging within the left cortical veins with surrounding T2/FLAIR hyperintensity in the adjacent cortex and white matter. No acute arterial territorial infarction is noted. What is the most likely diagnosis?
Answer choices
- AAcute ischemic stroke secondary to arterial thromboembolism
- BReversible cerebral vasoconstriction syndrome (RCVS)
- CRuptured arteriovenous malformation with intraparenchymal hemorrhage
- DCerebral venous sinus thrombosisCorrect answer
- EHypertensive intracerebral hemorrhage with secondary vasogenic edema
- FAcute subdural hematoma with mass effect
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