Question:medium
A case of sudden onset aphasia and right arm weakness for the last 5 hours is seen. Which investigation is indicated?
A case of sudden onset aphasia and right arm weakness for the last 5 hours is seen. Which investigation is indicated?
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In suspected embolic stroke, TEE can help identify cardiac or aortic sources of emboli.
Updated On: May 14, 2026
- MRI brain
- Carotid Doppler
- TEE
- Transthoracic echocardiography
Show Solution
The Correct Option is C
Solution and Explanation
Step 1: Understanding the Question:
The clinical presentation of sudden-onset aphasia and right-sided weakness is highly suggestive of an ischemic stroke in the left middle cerebral artery (MCA) territory. While imaging the brain (CT/MRI) is the first priority to rule out hemorrhage, the question likely asks for the investigation to find the source of the stroke.
Step 2: Detailed Explanation:
Source of Embolic Stroke: In many young patients or cases with suspected "cryptogenic" stroke, a cardioembolic source must be ruled out.
Transesophageal Echocardiography (TEE): TEE is far more sensitive than Transthoracic Echocardiography (TTE) for visualizing the left atrium, the left atrial appendage (a common site for clots in AF), and the interatrial septum (for Patent Foramen Ovale - PFO). It can also detect aortic arch atherosclerosis.
Indications for TEE in Stroke: It is the preferred study to look for high-risk cardioembolic sources when initial evaluations (like TTE and carotid imaging) are inconclusive or when a high suspicion of a cardiac source exists.
Why not others? While MRI brain (Option A) is the gold standard for diagnosing the infarct, it does not tell you why the stroke happened. Carotid Doppler (Option B) looks for large vessel disease in the neck but misses cardiac sources. TTE (Option D) has lower sensitivity for posterior cardiac structures compared to TEE.
Step 3: Final Answer:
Transesophageal Echocardiography (TEE) is the indicated investigation to rule out a cardioembolic source for an embolic-appearing stroke.
The clinical presentation of sudden-onset aphasia and right-sided weakness is highly suggestive of an ischemic stroke in the left middle cerebral artery (MCA) territory. While imaging the brain (CT/MRI) is the first priority to rule out hemorrhage, the question likely asks for the investigation to find the source of the stroke.
Step 2: Detailed Explanation:
Source of Embolic Stroke: In many young patients or cases with suspected "cryptogenic" stroke, a cardioembolic source must be ruled out.
Transesophageal Echocardiography (TEE): TEE is far more sensitive than Transthoracic Echocardiography (TTE) for visualizing the left atrium, the left atrial appendage (a common site for clots in AF), and the interatrial septum (for Patent Foramen Ovale - PFO). It can also detect aortic arch atherosclerosis.
Indications for TEE in Stroke: It is the preferred study to look for high-risk cardioembolic sources when initial evaluations (like TTE and carotid imaging) are inconclusive or when a high suspicion of a cardiac source exists.
Why not others? While MRI brain (Option A) is the gold standard for diagnosing the infarct, it does not tell you why the stroke happened. Carotid Doppler (Option B) looks for large vessel disease in the neck but misses cardiac sources. TTE (Option D) has lower sensitivity for posterior cardiac structures compared to TEE.
Step 3: Final Answer:
Transesophageal Echocardiography (TEE) is the indicated investigation to rule out a cardioembolic source for an embolic-appearing stroke.
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