General

Case Study/Discussion - 030916

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3 Sep 2016 - General
 

An 65 years old gentleman, background history of ischeamic heart disease (with coronary stent in situ), hypercholesterolemia, hypertension, was admitted to hospital due to sudden onset of left upper limb, left lower limb weakness with some slurred speech, lasting for around 30 minutes, with spontaneuos recovery. The symptoms was started when patient was eating his lunch, and felt sudenlly his left upper and lower limbs became very weak, and unable to stand up steadily. The wife noted his speech was slightly slurred as well. Ambulance was called to brought him to casualty. His symptoms was fully resolved when arrival to hospital. His neuroloy examination was all entirely normal, with no focal neurological defect. ECG showed sinus rthym. CT-Brain done showed no acute abnormality. But, CT-angiogram showed aound 80%-90% stenoisis of his righ internal carotid artery. What is your diagnosis ?? What is the important managemen plan for him??

Yes, Marinelle Castro this patient did have transient ischemic attack (as his symptoms resolved completely after 30 minutes) with symptomatic carotid artery stenosis. Carotid endarterectomy will be beneficial for him. The risk of recurrent stroke is high following a transient ischemic attack or stroke associated with symptomatic carotid /carotid stenosis. The timing for carotid endarterectomy is still debatable,...
 (Total 102 words)
The patient's illness is rightfully categorized as a transient ischemic attack. With the background of high-grade stenosis, hypercholesterolemia and ischemic heart disease, this patient needs to have a thorough vascular work up. This patient will actually benefit from either a carotid endartetectomy or a coronary artery stenting provided that whichever modality is done within 6 weeks after a vascular insult. Studies show that these procedures are comparable in preventing another stroke as a ...
 (Total 124 words)