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
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?