Question:medium
A patient known to have mitral stenosis and atrial fibrillation presents with acute onset of weakness in the left upper limb which recovered completely in two weeks. The most likely diagnosis is:
A patient known to have mitral stenosis and atrial fibrillation presents with acute onset of weakness in the left upper limb which recovered completely in two weeks. The most likely diagnosis is:
Show Hint
A deficit lasting two weeks is too long to be a TIA.
Updated On: Jun 24, 2026
- Transient ischemic attack
- Ischemic stroke
- Hemorrhagic stroke
- Vasculitis
Show Solution
The Correct Option is B
Solution and Explanation
Start with the heart. Tight mitral stenosis stretches the left atrium, and once atrial fibrillation sets in the atrium no longer empties properly. Blood pools, thrombus forms, and a fragment can shoot off into the cerebral circulation. That embolus lodges in an artery and starves a region of brain of oxygen.
Now weigh the timeline against the formal definitions. A transient ischemic attack is strictly time limited: the deficit must clear inside 24 hours with no tissue death. Here the arm weakness lasted a full two weeks. That alone rules a TIA out, because tissue infarction must have taken place for a deficit to last that long.
Persistence beyond a day is the textbook line that defines a completed stroke. The later return of strength simply reflects the brain's capacity to recover function around an infarct; it does not downgrade the event to a TIA.
Choosing the subtype is straightforward once the mechanism is clear. An embolus blocking flow produces an $ischemic$ infarct, not a bleed, so hemorrhagic stroke is wrong. Vasculitis is an inflammatory arteritis unrelated to a clear cardioembolic source like mitral stenosis with AF.
\[\boxed{\text{Ischemic stroke}}\]
Now weigh the timeline against the formal definitions. A transient ischemic attack is strictly time limited: the deficit must clear inside 24 hours with no tissue death. Here the arm weakness lasted a full two weeks. That alone rules a TIA out, because tissue infarction must have taken place for a deficit to last that long.
Persistence beyond a day is the textbook line that defines a completed stroke. The later return of strength simply reflects the brain's capacity to recover function around an infarct; it does not downgrade the event to a TIA.
Choosing the subtype is straightforward once the mechanism is clear. An embolus blocking flow produces an $ischemic$ infarct, not a bleed, so hemorrhagic stroke is wrong. Vasculitis is an inflammatory arteritis unrelated to a clear cardioembolic source like mitral stenosis with AF.
\[\boxed{\text{Ischemic stroke}}\]
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