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
This is most likely a case of transient ischemic attack (TIA). It is also known as “mini-strokes”. It occurs when blood supply of the brain is temporarily blocked. It lasts for a few minutes up to an hour and leaves no permanent damage. The most common cause of TIA is carotid artery stenosis which is mainly caused by atherosclerosis. CT scan of the head is the first step of action to exclude cerebral hemorrhage or stroke. Carotid duplex ultrasonography is scheduled if it TIA occurs again or in suspected patients.
The correct answer is E