Question

A 65-year-old male presented with history of TIA, transient right upper limb weakness, diagnosed to have bilateral carotid artery stenosis on colour doppler.
How would you evaluate this patient?

Hint:

In patients with TIA and carotid artery stenosis, it's essential to assess both the degree of stenosis and the presence of collateral circulation to determine the treatment approach.

Answer 1

Step 1: Understanding the clinical context.
The patient has a history of transient ischemic attack (TI, which suggests that there is a temporary disruption in blood flow to the brain. The right upper limb weakness indicates a possible neurological deficit, often linked to carotid artery stenosis. Bilateral carotid artery stenosis seen on color Doppler further supports the diagnosis of potential cerebrovascular disease.

Step 2: Evaluation approach.
The patient should undergo a thorough evaluation to assess the severity of carotid artery stenosis and its impact on brain perfusion. Key steps in evaluation include:
1. Detailed clinical history: Including the onset, duration, and progression of symptoms (TIA, limb weakness) and risk factors (hypertension, smoking, diabetes, hyperlipidemi.
2. Neurological examination: Assessing the severity of neurological deficits and identifying any residual weakness or signs of cerebrovascular disease.
3. Imaging studies: A repeat carotid ultrasound or CT angiography/MRI angiography may be needed to confirm the degree of stenosis and visualize the plaque morphology and location.
4. Assessment of cerebral perfusion: Using transcranial Doppler or cerebral angiography to assess blood flow to the brain and identify areas at risk.

Step 3: Conclusion.
A combination of clinical evaluation, neurological examination, and imaging studies will help assess the severity of the stenosis and guide further management.