Case 3

A 43-year-old woman arrives in your ED. She had been seen three days earlier after a fall from a horse. She had landed on her right shoulder. It was possible that she lost consciousness briefly.

After assessment, she was found to have a fractured scapula. She was treated with a broad arm sling and fracture clinic follow-up was arranged.

Since the fall, she has had a persistent right sided headache. Two days after the fall, she noticed numbness of her right cheek and attended the ED again.

On examination, the triage nurse notices a small right pupil. Examining her, you find a right Horner’s syndrome, decreased sensation over her right cheek and a right carotid bruit.

You arrange a CT brain scan, which is normal and request an MRA, which shows a carotid dissection.

What is her likely prognosis?

Select ONE morbidity factor and ONE mortality estimate.

What treatment will you start?