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* NBME neuro: very tricky and hard question!
 #846058  
  kennychan - 12/04/17 17:00
 
  A 77-year-old woman is brought to the emergency department 5 hours after the onset of dizziness, blurred vision, numbness of the right side of her face, and slurred speech. She has had three similar 30- to 40 minute episodes during the past 3 weeks. She feels well between episodes. She frequently has tinnitus in her left ear caused by chronic mastoiditis and neck pain caused by osteoarthritis. She undergoes cervical manipulation by a chiropractor four times monthly. She underwent coronary artery bypass grafting 4 years ago. Medications include clopidogrel and isosorbide. Her pulse is 85/min, respiration are 20/min, and blood pressure is 140/104 mm Hg. Examination, including neurologic examination, shows no abnormalities except for a well-healed midline sternal scar. A CT scan of the head and an MRI of the brain show no abnormalities. Magnetic resonance angiography shows dissection of the right vertebral artery. Which of the following is the most appropriate immediate pharmacotherapy?
a) Intravenous heparin
b) Intravenous tissue plasminogene activator (wrong)
c) Intavenous urokinase
d) Oral dipyridamole (wrong
e) Oral warfarin
 
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* Re:NBME neuro: very tricky and hard question!
#3354259
  amrith277 - 12/04/17 22:28
 
  Is it A) IV Heparin.  
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* Re:NBME neuro: very tricky and hard question!
#3354261
  kennychan - 12/04/17 22:45
 
  I agree, only IV heparin makes sense in this case.  
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* Re:NBME neuro: very tricky and hard question!
#3354262
  kennychan - 12/04/17 22:47
 
  In addition, dissection of vertebral artery will cause blood clots.  
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