Vascular Disease USMLE Step 1 Practice Question
A 52-year-old woman with no prior migraine history presents with sudden-onset severe frontal headache, neck stiffness, and left-sided weakness. Vital signs: BP 156/92 mmHg, HR 98/min, RR 16/min, temp 37.2°C, SpO2 98% on room air. MR angiography demonstrates right carotid artery dissection with 80% stenosis and intimal flap. Serum glucose is 105 mg/dL. Which mechanism best explains ischemic stroke development in carotid dissection?
Answer choices
- AIncreased intracranial pressure from venous outflow obstruction
- BArterial rupture causing hemorrhagic transformation
- CThromboembolism from the dissected vessel and/or flow-limiting stenosisCorrect answer
- DTransient hypoxia from global hypoperfusion
- EAcute vasospasm of the carotid artery
- FDissection-induced vasodilation leading to increased cerebral blood flow and metabolic demand
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