07-22-2009, 08:53 AM
A 69-year-old man comes to the emergency department complaining of dizziness. While at the shopping mall with his wife, he suddenly found himself unable to keep his balance. The room suddenly seemed tilted and began to spin. While he does not think he blacked out, he became confused and had blurred, double vision. He felt as if his head, arms, and legs were made of lead, and suddenly felt as if the floor were rushing up at him. He denies any pain or altered sensation, aside from a ringing in his ears, now resolved. According to his wife, while the patient never lost consciousness during this episode, he did slur his words and had difficulty keeping his eyes open. By the time the paramedics arrived, however, his symptoms had completely resolved. The patient is admitted for an expediated evaluation of his transient ischemic attack (TIA) symptoms. Physical examination and vital signs, as well as a carotid ultrasound and set of routine laboratory studies, are unremarkable. Based on the patient™s history, which of the following was the most likely affected?
A. Internal carotid artery
B. Middle cerebral artery
C. Penetrating thalamic branches
D. Posterior inferior cerebellar circulation
E. Vertebrobasilar circulation
A. Internal carotid artery
B. Middle cerebral artery
C. Penetrating thalamic branches
D. Posterior inferior cerebellar circulation
E. Vertebrobasilar circulation