R U smart in Neurology?..

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R U smart in Neurology?..

Post  Ahmed Al-Kaisy on Sat Dec 29, 2007 9:35 am

A 75 years old man is brought to the emergency department by his family after having had several episodes of slurred speech at home. his history is notable for hypertension, tobbaco abuse, and DM, which has been marginally controlled with diet. he is currently asymptomatic with a BP of 150/80 and a normal neurological examination. cardiac examination reveals an S4 gallop but no murmurs. carotid bruits are heard bilaterally.ECG demonstrates normal sinus rhythm without ST or T-waves changes. CT of the head is pending.

1- what is the probable diagnosis?

2- what is the Appropriate initial evaluation and treatment?and why?

a- IV heparin if CT negative for intracranial hemorrhage.
b- antiplatelet therapy, blood pressure control, and carotid ultrasound.
c- lumbar puncture.
d- antiplatelet therapy and echo.
e-blood pressure control and MRI of the brain.

Ahmed Al-Kaisy

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Re: R U smart in Neurology?..

Post  Mohammad Tayeb on Tue Jan 01, 2008 3:05 am

HI...Happy NEW Year 2008:
The Dx is Transient Ischaemic Attack (TIA).
The Appropriate initial evaluation and treatment are: antiplatelet therapy, blood pressure control, and carotid ultrasound.
Since the patient has multiple risk factors for atherosclerosis (hypertension, tobbaco abuse, and DM)....also he had bruit in the carotid artery...so probably the atherosclerosis affected it causing stenosis which result in TIA...inorder to check it we do carotid ultrasound.
So we give him antiplatelets therapy (which is the mainstay of treatment) to prevent the TIA, control of BP,..& advice him to stop smoking, better control of DM & regular exercise.

Mohammad Tayeb

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Location : Baghdad / Iraq

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