A 76-year-old woman comes to your office for a consultation. Yesterday, she had left hemiparesis for 30 minutes. She thought it was a stroke but now she is completely asymptomatic. She has a history of atrial fibrillation, angina and hypertension. She takes aspirin 81 mg and propranolol 80 mg.
What is your appropriate initial management for this patient?
A- Schedule another appointment whenever she has symptoms
B- Schedule transesophageal echocardiography
C- Schedule carotid duplex ultrasonography
D- Schedule MRI to the brain
E- Obtain CT scan of the head
Answer:
Any case of suspected stroke should be evaluated instantly with CT scan. This case is most likely to be stenosis of carotid and needs carotid duplex but this is a later step. The question asks for initial step and it should be a CT scan as it is available now in urgent care facilities.
The correct answer is E
True! Thanks for your comment Dr. Qaisar
If it resolved in 30 min it mean its TIA.
AF can lead to thrombus so y not to do trans echo yo rule thrombus in heart.
She is fine now it mean that she had no neuronal damage or any bleed.
It is selective but not relevant in most cases especially after the incident. Thanks for your comment Dr Amna
I guess ct scan is also relevant for TIA
Thank you Dr David for this information.
The new definition of stroke(you can check it up) is the demonstration of neuronal damage/death irrespective of the duration of symptom, and this can occur in brain, retina and spine!
Thank you Dr Ahmad. A good comment and that is why we start by doing CT Scan to confirm either way.
I don’t think that it is the case of carotid stenosis .
But it seems to be the case arterial thrombus due to atrial fibrillation .
Why would I suspect stroke if it resolved spontaneously within 30 mins? Isn’t it TIA?