19th August 2024

You are asked to review a man on the general medical ward with a new neurological disturbance

You are asked to review a man on the general medical ward with a new neurological disturbance. He is a 72-year-old with a background of ischaemic heart disease and hypertension, and is a smoker. He was admitted to hospital with a community acquired pneumonia. Following admission, he became septic and delirious. He required escalation of his antibiotics and several fluid boluses. The following morning on the ward round, it was noted that he was struggling to speak to the consultant. An ECG was normal and a CT scan demonstrated no haemorrhage so he was given aspirin. On your examination, he is aphasic, and has a right homonymous hemianopia with right sided neglect. Examination on admission revealed no focal neurological signs. You arrange an ultrasound carotid doppler and an MRI scan. The carotid dopplers demonstrates 80% carotid stenosis on the left and 40% stenosis on the right. The MRI demonstrates several infarcts in a ‘string of pearls’ formation. What is the likely cause of this patient’s stroke?

Select the SINGLE most appropriate option from the list below. Select ONE option only.