Neurology — MCQs
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A 45-year-old woman attends the Emergency Department with a 4-hour history of severe left-sided headache, photophobia, and vomiting. She has a history of migraine with aura. On examination, she is alert, afebrile, with normal fundoscopy and no focal neurological signs. CT head performed 6 hours after onset shows no abnormality. What is the most appropriate next investigation?
A 33-year-old woman presents to neurology clinic with a 5-year history of episodic attacks during sleep. Her partner describes that she suddenly sits up, appears frightened, and makes cycling movements with her legs for about 30 seconds before lying back down. She has no memory of these events. Episodes occur 2-3 times per week. Routine EEG shows no abnormalities. What is the most likely diagnosis?
A 68-year-old man with a history of hypertension and hyperlipidaemia presents with two episodes of left arm weakness and slurred speech in the past week, each lasting approximately 15 minutes and resolving completely. Carotid duplex ultrasonography shows 75% stenosis of the right internal carotid artery. He is currently taking aspirin 75 mg, atorvastatin 80 mg, and amlodipine 10 mg daily. What is the most appropriate next step in management?
A 26-year-old woman with focal epilepsy has been seizure-free for 3 years on lamotrigine 200 mg twice daily. She wishes to discontinue her medication as she is planning pregnancy and is concerned about teratogenicity. Her EEG performed 6 months ago showed occasional sharp waves in the left temporal region. She drives regularly for work. What is the most appropriate advice regarding medication discontinuation?
A 70-year-old woman presents to the Emergency Department 3 hours after sudden onset left arm weakness and facial droop. Her NIHSS score is 8. CT head shows no haemorrhage or early ischaemic changes. Blood glucose is 6.2 mmol/L, BP 178/95 mmHg. She takes aspirin 75 mg and atorvastatin 40 mg daily. Her estimated GFR is 55 ml/min/1.73m². She has no history of recent surgery or bleeding. What is the most appropriate immediate management?
A 59-year-old woman with a history of migraines presents with sudden onset severe headache different from her usual migraines. CT head performed 8 hours after symptom onset shows no abnormality. She has mild photophobia and neck stiffness. Blood pressure is 168/94 mmHg. Which investigation should be performed next?
What is the characteristic EEG finding in Creutzfeldt-Jakob disease?
A 77-year-old man is being treated for an acute ischaemic stroke affecting the left middle cerebral artery territory. On day 3 of admission, he develops worsening confusion, agitation, and a fluctuating level of consciousness. His speech is incoherent. Temperature is 37.2°C, respiratory rate 24/min, oxygen saturation 91% on air. What is the most likely cause of his deterioration?
A 35-year-old woman presents with a 6-week history of daily headache. She describes a constant, bilateral, pressing sensation like a tight band around her head. The headache is present all day but varies in intensity. There is no nausea, photophobia, or visual symptoms. Neurological examination is normal. What is the most appropriate management?
A 53-year-old man presents with a 2-hour history of sudden onset binocular diplopia, dysarthria, and bilateral limb weakness. He has a history of hypertension. Examination reveals bilateral sixth nerve palsies, dysarthria, and quadriparesis. CT head shows a hyperdense lesion in the pons. What is the most likely diagnosis?
Neurology UK Medical PG Practice Questions and MCQs
Question 61: A 45-year-old woman attends the Emergency Department with a 4-hour history of severe left-sided headache, photophobia, and vomiting. She has a history of migraine with aura. On examination, she is alert, afebrile, with normal fundoscopy and no focal neurological signs. CT head performed 6 hours after onset shows no abnormality. What is the most appropriate next investigation?
- A. MRI brain with gadolinium contrast
- B. Lumbar puncture with CSF analysis (Correct Answer)
- C. CT angiography of cerebral vessels
- D. Repeat CT head after 12 hours
- E. No further investigation required
Explanation: ***Lumbar puncture with CSF analysis*** - In patients with a suspected **subarachnoid haemorrhage (SAH)** and a negative **CT head** performed more than 6 hours after onset, a **lumbar puncture** is mandatory to exclude the diagnosis. - The CSF must be analysed for **xanthochromia** (the breakdown products of hemoglobin) which usually takes **12 hours** to develop post-ictus. *MRI brain with gadolinium contrast* - While useful for detecting **ischaemic strokes** or **tumors**, MRI is not the gold standard or immediate next step for excluding an acute **SAH** when CT is negative. - It is less sensitive than **CSF analysis** for detecting blood products in the very early subacute phase of a hemorrhage. *CT angiography of cerebral vessels* - This is primarily used to identify the source of bleeding, such as a **berry aneurysm**, once a **SAH** has been confirmed by CT or CSF. - It is not a screening tool to rule out the presence of **subarachnoid blood** itself in the initial diagnostic pathway. *Repeat CT head after 12 hours* - Repeating a **non-contrast CT** is not indicated as the sensitivity for blood actually **decreases** over time as the blood is reabsorbed and becomes isodense. - Failure to visualize blood on the initial scan mandates moving to **CSF analysis** rather than delayed imaging. *No further investigation required* - Relying on a history of **migraine** is dangerous in the context of a sudden-onset "thunderclap" headache, which must be treated as **SAH** until proven otherwise. - Clinical guidelines require definitive exclusion of life-threatening pathology through **LP and xanthochromia** if the 6-hour CT window is exceeded or the scan is negative.
Question 62: A 33-year-old woman presents to neurology clinic with a 5-year history of episodic attacks during sleep. Her partner describes that she suddenly sits up, appears frightened, and makes cycling movements with her legs for about 30 seconds before lying back down. She has no memory of these events. Episodes occur 2-3 times per week. Routine EEG shows no abnormalities. What is the most likely diagnosis?
- A. Frontal lobe epilepsy (Correct Answer)
- B. Non-REM parasomnia (sleep terror)
- C. REM sleep behaviour disorder
- D. Psychogenic non-epileptic seizures
- E. Temporal lobe epilepsy
Explanation: ***Frontal lobe epilepsy***- Characterized by brief, nocturnal seizures with **bizarre motor automatisms** such as cycling and thrashing, often lasting less than 60 seconds with rapid recovery.- **Routine EEG** is frequently normal as the seizure focus is often deep or obscured by muscle artifact, requiring video-telemetry for confirmation.*Non-REM parasomnia (sleep terror)*- Typically occurs during the **first third of the night** (slow-wave sleep) and features longer durations of autonomic arousal without the coordinated cycling movements seen here.- Less frequent than nocturnal epilepsy and usually lacks the **stereotyped motor patterns** and high frequency of occurrence (2-3 times per week).*REM sleep behaviour disorder*- Usually involves **complex, purposeful movements** that reflect dream enactment and typically occurs in the latter half of the night when REM sleep is most frequent.- Predominantly affects **older adults** and is often associated with neurodegenerative diseases like Parkinson's disease.*Psychogenic non-epileptic seizures*- Usually occur during **wakefulness** rather than sleep, though they may give the appearance of nocturnal events; they are typically much longer in duration.- Often characterized by **emotional triggers**, pelvic thrusting, and variable semiology rather than the brief, stereotyped motor activity described.*Temporal lobe epilepsy*- These seizures are more likely to occur during wakefulness and involve **oroalimentary or manual automatisms** rather than large-scale cycling movements.- Commonly associated with a preceding **aura** (epigastric rising, fear, or deja vu) and post-ictal confusion, which is less prominent in frontal lobe seizures.
Question 63: A 68-year-old man with a history of hypertension and hyperlipidaemia presents with two episodes of left arm weakness and slurred speech in the past week, each lasting approximately 15 minutes and resolving completely. Carotid duplex ultrasonography shows 75% stenosis of the right internal carotid artery. He is currently taking aspirin 75 mg, atorvastatin 80 mg, and amlodipine 10 mg daily. What is the most appropriate next step in management?
- A. Continue current medical management and repeat imaging in 3 months
- B. Add clopidogrel 75 mg to aspirin for 21 days then continue aspirin alone
- C. Arrange urgent carotid endarterectomy within 14 days of symptom onset (Correct Answer)
- D. Switch from aspirin to warfarin with target INR 2-3
- E. Arrange carotid artery stenting within 4 weeks
Explanation: ***Arrange urgent carotid endarterectomy within 14 days of symptom onset*** - This patient presents with **symptomatic carotid artery stenosis** (transient ischemic attacks) and 75% stenosis, putting him at high risk for a major stroke. - Current guidelines recommend **carotid endarterectomy (CEA)** for patients with 70-99% symptomatic stenosis, ideally performed within **14 days** of symptom onset to maximize stroke risk reduction. *Continue current medical management and repeat imaging in 3 months* - **Medical management** alone is insufficient for symptomatic high-grade stenosis (75%) as the risk of future stroke remains high without mechanical revascularization. - Delaying treatment with **repeat imaging** would miss the crucial window for optimal benefit from surgical intervention in preventing a completed stroke. *Add clopidogrel 75 mg to aspirin for 21 days then continue aspirin alone* - While **dual antiplatelet therapy (DAPT)** is a common adjunct after TIA, it does not replace the need for **mechanical revascularization** in the presence of >70% stenosis. - DAPT aims to reduce short-term risk, but **CEA** is the definitive treatment required to address the underlying anatomical cause of the emboli. *Switch from aspirin to warfarin with target INR 2-3* - **Anticoagulation** with warfarin is indicated for cardioembolic stroke (e.g., in **atrial fibrillation**) but is not superior to antiplatelets for large-vessel **atherosclerotic disease**. - Warfarin carries a higher risk of **intracranial hemorrhage** and does not directly address the carotid narrowing causing the patient's symptoms. *Arrange carotid artery stenting within 4 weeks* - **Carotid artery stenting (CAS)** is generally reserved for patients at high **surgical risk** or those with specific anatomical challenges preventing CEA. - **Carotid endarterectomy** is typically the preferred gold standard for most patients and should be performed more urgently (within 14 days), rather than waiting 4 weeks.
Question 64: A 26-year-old woman with focal epilepsy has been seizure-free for 3 years on lamotrigine 200 mg twice daily. She wishes to discontinue her medication as she is planning pregnancy and is concerned about teratogenicity. Her EEG performed 6 months ago showed occasional sharp waves in the left temporal region. She drives regularly for work. What is the most appropriate advice regarding medication discontinuation?
- A. Discontinue lamotrigine immediately as it is teratogenic
- B. Switch to levetiracetam before attempting pregnancy
- C. Reduce lamotrigine by 25% every 2-3 months and inform DVLA if proceeding (Correct Answer)
- D. Continue lamotrigine at the lowest effective dose during pregnancy
- E. Discontinue lamotrigine only after becoming pregnant
Explanation: ***Reduce lamotrigine by 25% every 2-3 months and inform DVLA if proceeding***- For patients seizure-free for over 2 years, **gradual withdrawal** (typically 25% reduction every 2-3 months) can be considered, but the patient must be warned of a 40-50% **recurrence risk** exacerbated by her abnormal EEG.- Legal driving requirements (like those of the **DVLA**) necessitate that the patient stops driving during the withdrawal period and for 6 months after the final dose, due to the risk of **seizure recurrence**.*Discontinue lamotrigine immediately as it is teratogenic*- **Abrupt discontinuation** of antiepileptic drugs is contraindicated as it carries a high risk of **rebound seizures** and potentially life-threatening status epilepticus.- Compared to other antiepileptic drugs like valproate, **lamotrigine** is considered one of the safer options during pregnancy with a relatively low **teratogenic risk**.*Switch to levetiracetam before attempting pregnancy*- **Levetiracetam** and lamotrigine have similar safety profiles in pregnancy; switching an already stable patient to a new drug introduces unnecessary risk of **seizure breakthrough** and is not the goal of medication discontinuation.- The patient's primary concern is to discontinue medication due to teratogenicity fears; switching to another AED does not achieve her goal of being **medication-free**.*Continue lamotrigine at the lowest effective dose during pregnancy*- While **lamotrigine** is considered relatively safe in pregnancy, this option contradicts the patient's stated wish to **discontinue medication** due to concerns about teratogenicity.- If continuing, she would need **high-dose folic acid** (5mg) to further mitigate any potential risks, although lamotrigine has a lower risk profile than many other AEDs.*Discontinue lamotrigine only after becoming pregnant*- Discontinuing or significantly changing antiepileptic therapy **during pregnancy** is generally avoided as it exposes the fetus to both the drug's potential effects and the hazards of uncontrolled maternal seizures.- Any planned withdrawal or dose adjustment should ideally be completed **pre-conception** to allow for clinical stability and assessment of seizure recurrence risk before pregnancy.
Question 65: A 70-year-old woman presents to the Emergency Department 3 hours after sudden onset left arm weakness and facial droop. Her NIHSS score is 8. CT head shows no haemorrhage or early ischaemic changes. Blood glucose is 6.2 mmol/L, BP 178/95 mmHg. She takes aspirin 75 mg and atorvastatin 40 mg daily. Her estimated GFR is 55 ml/min/1.73m². She has no history of recent surgery or bleeding. What is the most appropriate immediate management?
- A. Administer intravenous alteplase 0.9 mg/kg (Correct Answer)
- B. Load with aspirin 300 mg and start dual antiplatelet therapy
- C. Lower blood pressure to <140/90 mmHg before further treatment
- D. Arrange urgent CT angiography before thrombolysis
- E. Arrange urgent thrombectomy without thrombolysis
Explanation: ***Administer intravenous alteplase 0.9 mg/kg*** - The patient presents within the **3-hour window** of symptom onset, which is well within the **4.5-hour therapeutic window** for IV thrombolysis in eligible patients. - The **CT head shows no hemorrhage** and her **blood pressure (178/95 mmHg)** is below the **185/110 mmHg threshold** required for safe administration of alteplase, with no other contraindications. *Load with aspirin 300 mg and start dual antiplatelet therapy* - **Antiplatelet agents** like aspirin should be **delayed for 24 hours** after intravenous thrombolysis to minimize the risk of hemorrhagic transformation. - While antiplatelets are crucial for secondary prevention and acute stroke if thrombolysis is contraindicated, **alteplase** is the priority for eligible patients within the hyperacute window. *Lower blood pressure to <140/90 mmHg before further treatment* - Aggressive blood pressure lowering to **<140/90 mmHg** is generally avoided in the acute phase of ischemic stroke as it can worsen cerebral perfusion. - Blood pressure should only be lowered if it exceeds **185/110 mmHg** (for thrombolysis) or **220/120 mmHg** (if not thrombolysing), and her current BP is within the acceptable range for alteplase. *Arrange urgent CT angiography before thrombolysis* - **Thrombolysis should not be delayed** for advanced imaging like **CT Angiography (CTA)** if the non-contrast CT is clear and the patient is within the time window. - While CTA is useful for identifying **large vessel occlusion** for potential thrombectomy, the priority is to administer IV alteplase as quickly as possible ("**time is brain**"). *Arrange urgent thrombectomy without thrombolysis* - **Intravenous thrombolysis** is the initial first-line treatment for eligible patients with acute ischemic stroke, even if a **large vessel occlusion** is suspected. - **Mechanical thrombectomy** is typically performed *after* or *in conjunction with* IV thrombolysis, especially if the patient is within the extended window or has a large vessel occlusion, unless there are direct contraindications to alteplase which are not present here.
Question 66: A 59-year-old woman with a history of migraines presents with sudden onset severe headache different from her usual migraines. CT head performed 8 hours after symptom onset shows no abnormality. She has mild photophobia and neck stiffness. Blood pressure is 168/94 mmHg. Which investigation should be performed next?
- A. Lumbar puncture (Correct Answer)
- B. CT angiography
- C. MRI brain with gadolinium
- D. Repeat CT head in 24 hours
- E. Digital subtraction angiography
Explanation: ***Lumbar puncture*** - A **lumbar puncture** is the mandatory next step to exclude **subarachnoid hemorrhage (SAH)** when the clinical suspicion is high (e.g., sudden onset 'thunderclap' headache, meningism) but the initial **CT head** is negative. - It is ideally performed **12 hours** after symptom onset to look for **xanthochromia** via spectrophotometry, which distinguishes true hemorrhage from a traumatic tap. *CT angiography* - **CT angiography** is used to identify the source of bleeding (like an **aneurysm**) once a diagnosis of SAH is confirmed, but it is not sensitive enough to exclude the presence of blood in the subarachnoid space itself. - Using it before confirming SAH via LP could lead to identifying incidental aneurysms that are not the cause of the patient's symptoms. *MRI brain with gadolinium* - While **MRI** can detect blood in later stages, it is not the standard of care for diagnosing **acute subarachnoid hemorrhage** in the emergency setting due to longer acquisition times and lower sensitivity in the acute phase. - **Gadolinium enhancement** is more useful for identifying tumors or inflammatory processes rather than acute vascular events like SAH. *Repeat CT head in 24 hours* - Repeating a **CT head** is not indicated because the sensitivity of CT for SAH **decreases** over time as blood is cleared or diluted by CSF, especially after 6-12 hours. - Delaying further investigation with a repeat scan would dangerously postpone the diagnosis and potential treatment of a **ruptured aneurysm**. *Digital subtraction angiography* - **Digital subtraction angiography (DSA)** is an invasive gold-standard procedure for characterizing **vascular malformations** and planning surgical or endovascular intervention. - It is not performed as a primary screening tool for SAH because it carries risks of **stroke** and does not confirm the presence of subarachnoid blood directly.
Question 67: What is the characteristic EEG finding in Creutzfeldt-Jakob disease?
- A. Periodic sharp wave complexes (Correct Answer)
- B. 3 Hz spike and wave discharges
- C. Alpha coma pattern
- D. Focal temporal lobe slowing
- E. Continuous spike and wave in slow-wave sleep
Explanation: ***Periodic sharp wave complexes*** - In **Creutzfeldt-Jakob disease (CJD)**, the EEG typically demonstrates **periodic synchronous biphasic or triphasic sharp wave complexes** occurring at a frequency of approximately **1 Hz**. - This pattern is seen in about **60-70%** of patients with sporadic CJD, usually during the **middle to late stages** of the disease course. *3 Hz spike and wave discharges* - This is the classic EEG hallmark of **Absence Epilepsy**, manifesting as brief episodes of impaired consciousness. - Unlike the **rapidly progressive dementia** of CJD, this pattern is associated with a specific pediatric seizure disorder. *Alpha coma pattern* - Characterized by widespread, **non-reactive alpha activity** in the absence of consciousness, reflecting severe **diffuse encephalopathy** or brainstem injury. - This pattern typically occurs after **cardiac arrest** or profound hypoxia, rather than primary prion neurodegeneration. *Focal temporal lobe slowing* - This finding is more suggestive of a focal process like **Herpes Simplex Encephalitis** or a structural lesion within the temporal lobe. - CJD usually presents with **diffuse cortical involvement** rather than isolated focal temporal changes on initial assessment. *Continuous spike and wave in slow-wave sleep* - This EEG pattern is diagnostic for **Landau-Kleffner syndrome** or other specific pediatric epileptic encephalopathies. - It characteristically appears during **Non-REM sleep** and is associated with **acquired aphasia**, not the myoclonus seen in CJD.
Question 68: A 77-year-old man is being treated for an acute ischaemic stroke affecting the left middle cerebral artery territory. On day 3 of admission, he develops worsening confusion, agitation, and a fluctuating level of consciousness. His speech is incoherent. Temperature is 37.2°C, respiratory rate 24/min, oxygen saturation 91% on air. What is the most likely cause of his deterioration?
- A. Urinary tract infection
- B. Haemorrhagic transformation of the infarct
- C. Recurrent stroke
- D. Hypoxia secondary to aspiration pneumonia (Correct Answer)
- E. Post-stroke seizure
Explanation: ***Hypoxia secondary to aspiration pneumonia***- The patient presents with **tachypnea** and **hypoxia** (SpO2 91%), which are specific clinical indicators of a respiratory complication rather than a purely neurological or urinary event.- **Aspiration pneumonia** is a very common complication following an acute stroke due to **dysphagia** and impaired consciousness, leading to **delirium** and fluctuating consciousness as seen here.*Urinary tract infection*- While **UTI** is a frequent cause of **post-stroke delirium**, it does not typically cause a drop in **oxygen saturation** or a high **respiratory rate**.- This diagnosis should only be considered secondary after ruling out more acute causes of **hypoxia** and respiratory distress.*Haemorrhagic transformation of the infarct*- This complication usually manifests as a sudden **neurological decline** or worsening of focal deficits, rather than isolated **delirium and hypoxia**.- While it can occur within the first few days of a large **MCA territory stroke**, it does not explain the patient's **respiratory compromise**.*Recurrent stroke*- Recurrent stroke would typically present with **new focal neurological signs** (e.g., new limb weakness or cranial nerve deficit) that were not previously present.- It is less likely than a medical complication on **day 3** and would not inherently cause **hypoxia** unless it involves the brainstem severely.*Post-stroke seizure*- **Seizures** can cause a **post-ictal state** with confusion and agitation, but they are unlikely to cause sustained **hypoxia** and tachypnea after the event ends.- While seizures occur in a small percentage of stroke patients, the primary focus must remain on the **respiratory findings** in this clinical picture.
Question 69: A 35-year-old woman presents with a 6-week history of daily headache. She describes a constant, bilateral, pressing sensation like a tight band around her head. The headache is present all day but varies in intensity. There is no nausea, photophobia, or visual symptoms. Neurological examination is normal. What is the most appropriate management?
- A. Start amitriptyline 10 mg at night (Correct Answer)
- B. Prescribe sumatriptan 50 mg as required
- C. Arrange urgent MRI head
- D. Advise simple analgesia as required
- E. Start propranolol 40 mg twice daily
Explanation: ***Start amitriptyline 10 mg at night*** - This patient presents with a **chronic tension-type headache (TTH)**, indicated by a daily bilateral, "tight band" sensation lasting more than 15 days per month for over 3 months. - **Amitriptyline** is the first-line preventive treatment for chronic TTH and is started at a low dose to improve sleep and modulate pain pathways. *Prescribe sumatriptan 50 mg as required* - **Sumatriptan** is a triptan used specifically for the acute treatment of **migraines** and cluster headaches, not tension-type headaches. - It is ineffective for TTH and is contraindicated if the diagnosis does not involve **vascular** or neurogenic inflammatory components typical of migraines. *Arrange urgent MRI head* - Neuroimaging is not indicated as there are no **red flags** such as papilledema, focal neurological deficits, or sudden "thunderclap" onset. - The **neurological examination** is normal, and the patient’s symptoms are classic for a primary headache disorder rather than a structural lesion. *Advise simple analgesia as required* - While simple analgesics like paracetamol or NSAIDs are used for episodic TTH, daily use in chronic cases poses a high risk of **medication overuse headache**. - Prophylactic management is favored over acute treatment when headaches occur frequently enough to significantly impact quality of life. *Start propranolol 40 mg twice daily* - **Propranolol** is a beta-blocker primarily used for the prophylaxis of **migraines**, not tension-type headaches. - It is less effective than tricyclic antidepressants for the specific pathophysiology of **chronic TTH**.
Question 70: A 53-year-old man presents with a 2-hour history of sudden onset binocular diplopia, dysarthria, and bilateral limb weakness. He has a history of hypertension. Examination reveals bilateral sixth nerve palsies, dysarthria, and quadriparesis. CT head shows a hyperdense lesion in the pons. What is the most likely diagnosis?
- A. Pontine haemorrhage (Correct Answer)
- B. Basilar artery thrombosis
- C. Pontine glioma
- D. Multiple sclerosis relapse
- E. Posterior circulation ischaemic stroke
Explanation: ***Pontine haemorrhage***- Sudden onset of **binocular diplopia**, **dysarthria**, **bilateral limb weakness** (quadriparesis), and **bilateral sixth nerve palsies** in a patient with a history of **hypertension** is highly indicative of a pontine haemorrhage.- The non-contrast CT head showing a **hyperdense lesion in the pons** is the definitive finding for **acute intracranial haemorrhage**, as fresh blood appears bright on CT.*Basilar artery thrombosis*- While a basilar artery thrombosis can cause similar neurological deficits in the posterior circulation, a non-contrast CT head would typically show **hypodensity** (infarction) or be normal in the hyperacute phase, not a hyperdense lesion.- The **hyperdense lesion within the pons** on CT directly points to blood, differentiating it from an acute thrombotic occlusion.*Pontine glioma*- A pontine glioma would present with a **gradual, progressive worsening** of symptoms over weeks or months, not a sudden onset over 2 hours as described.- On CT, a glioma typically appears as an **expansile mass** with varying signal characteristics, often **hypodense** or mixed, rather than acutely hyperdense.*Multiple sclerosis relapse*- Multiple sclerosis relapses usually develop over **days to weeks** and are rarely of such sudden and severe onset (2 hours) with quadriparesis.- Acute demyelinating plaques in MS are typically **isodense or hypodense** on CT and are better visualized as hyperintense lesions on MRI.*Posterior circulation ischaemic stroke*- An ischaemic stroke, by definition, involves **tissue infarction** due to arterial occlusion, which would result in **hypodensity** on a non-contrast CT scan as oedema and cell death occur.- The presence of a **hyperdense lesion** on CT directly indicates **acute bleeding**, ruling out an ischaemic event.
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