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Clinical Pattern MCQ for FMGE NEXT Pattern

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  • Clinical Pattern MCQ for FMGE NEXT Pattern
A 70-year-old man retired from Indian postal service did not wake up from his sleep though he goes for early morning walks. His wife panicked as he is not waking up and called the ambulance services. On arrival at hospital his pulse rate is 70 per min with BP of 170/110 mm Hg. GCS is 8/15, bilateral long tract signs are noted with internuclear ophthalmoplegia. Which of the following will be correct about this case?
  1. The patient is having Lateral pontine syndrome and needs urgent CT head followed by thrombolysis
  2. The patient is having Lateral medullary syndrome and needs urgent CT head followed by thrombolysis
  3. The patient is having bilateral basiliar artery occlusion and thrombolysis will not be beneficial
  4. The patient is having bilateral anterior cerebral artery occlusion and thrombolysis will not be beneficial
The presence of bilateral long tracts signs is diagnostic of basiliar artery involvement. In people who develop stroke in their sleep, the onset is taken from sleep onset. Hence in this case the thrombolysis window is already closed and shall not be useful.