A 30-Year-Old Man Comes to the Emergency Department Due to Severe

question 136

Multiple Choice

A 30-year-old man comes to the emergency department due to severe headache and neck pain following a motor vehicle collision.  The patient has no blurry or double vision, dizziness, slurred speech, numbness, or weakness.  Neuroimaging is unremarkable except for evidence of a right transverse foramina fracture at the level of C2.  The patient is placed in a cervical collar and admitted to the hospital.  While undergoing further evaluation, he suddenly develops dizziness, right-sided facial numbness, and hoarseness.  Temperature is 36.7 C (98.1 F) , blood pressure is 160/90 mm Hg, pulse is 80/min, and respirations are 12/min.  Neurologic examination shows partial ptosis and miosis of the right eye, as well as nystagmus.  Hearing is intact bilaterally.  There is reduced sensation to pain and temperature on the right side of the face and the left side of the body.  The patient is ataxic and displays past-pointing with his right hand on finger-to-nose testing.  Vascular imaging will most likely reveal an acute dissection in which of the following arteries?

• A)Basilar
• B)Common carotid
• C)Internal carotid
• D)Middle cerebral
• E)Posterior cerebral
• F)Vertebral

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Definitions:

Sepal

One of the outermost parts of a flower, usually green and leaf-like, that protects the developing flower.

Leaflike

Having the appearance or characteristics of a leaf.

Disperse

The process by which organisms or particles spread or distribute from a concentrated area to more spread-out areas.