Question:
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:
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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
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Verified By Collegedunia
The Correct Option is B
Solution and Explanation
Step 1: Identify the source. Mitral stenosis with atrial fibrillation causes stasis of blood in the dilated left atrium. Clots form there and embolise to the brain. This is a classic cardioembolic source.
Step 2: Read the time course. The weakness was of acute onset and lasted two weeks before complete recovery. By definition a transient ischemic attack (TIA) is a focal neurological deficit that resolves within 24 hours and leaves no infarct. A deficit lasting two weeks is far longer than a TIA.
Step 3: Apply the definition of stroke. A neurological deficit that persists beyond 24 hours represents a completed stroke (infarction has occurred). The fact that it later recovered does not change the diagnosis, because functional recovery can happen even after an established infarct. So this is an ischemic stroke, not a TIA.
Step 4: Decide ischemic versus hemorrhagic. The mechanism here is embolism from the heart, which blocks an artery and causes ischemic infarction. Hemorrhagic stroke is bleeding, not the expected outcome of cardiac embolism. Vasculitis would give a different, more diffuse or relapsing picture and is not suggested by mitral stenosis with AF.
Conclusion: The two week duration excludes TIA, and the embolic mechanism makes this an ischemic stroke, option B.
Step 2: Read the time course. The weakness was of acute onset and lasted two weeks before complete recovery. By definition a transient ischemic attack (TIA) is a focal neurological deficit that resolves within 24 hours and leaves no infarct. A deficit lasting two weeks is far longer than a TIA.
Step 3: Apply the definition of stroke. A neurological deficit that persists beyond 24 hours represents a completed stroke (infarction has occurred). The fact that it later recovered does not change the diagnosis, because functional recovery can happen even after an established infarct. So this is an ischemic stroke, not a TIA.
Step 4: Decide ischemic versus hemorrhagic. The mechanism here is embolism from the heart, which blocks an artery and causes ischemic infarction. Hemorrhagic stroke is bleeding, not the expected outcome of cardiac embolism. Vasculitis would give a different, more diffuse or relapsing picture and is not suggested by mitral stenosis with AF.
Conclusion: The two week duration excludes TIA, and the embolic mechanism makes this an ischemic stroke, option B.
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