A 76-year-old women presents to the emergency department (ED) for evaluation of slurred speech, dizziness, and severe headache of sudden onset. The symptoms lasted about 10 minutes and then resolved. Her son is afraid she suffered a stroke and has brought her to the ED. Two similar episodes occurred during the past 2 weeks, but she refused medical attention.
She denies shortness of breath, nausea, vomiting, syncope, and symptoms of aura, as well as focal motor weakness and loss of sensation.
The patient has had hypertension for 10 years and also has hyperlipidemia and migraine. She was formerly a one-pack-a-day smoker but quit 5 years earlier. She has no history of heavy drinking or drug abuse. She has no known drug allergies. Family history is notable for stroke in her mother at age 80.
Her medications are lisinopril 40 mg daily, aspirin 81 mg daily, and atorvastatin 10 mg daily.
The woman is resting calmly. She is slightly overweight, with a body mass index of 27. Blood pressure is 145/90 mm Hg; heart rate, 85 beats/min, with normal sinus rhythm.
Results of physical and neurological examinations are unremarkable. No carotid bruits are appreciated. ABCD2 score is 3.
Blood glucose level, complete blood cell count, electrolyte levels, blood urea nitrogen and creatinine levels, and international normalized ratio (INR) are within normal limits.
A head CT scan is normal with no evidence of bleeding. A carotid ultrasound scan shows moderate stenosis of the left internal carotid artery.
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