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A 30-year-old man comes to the clinic reporting a brief episode of œtalking funny at work 4 days ago. He describes the episode as lasting 4-5 minutes, during which he felt he had difficulty speaking and his colleagues thought he was slurring his words. At that time he also had difficulty holding his pen. The symptoms resolved after this episode and have not recurred. He has not had any prior episodes. He has no medical condition and is not receiving any medications. His blood pressure is 120/80 mm Hg and pulse is 70/min. Heart is regular, with a normal S1 and a physiologically split S2. There are no murmurs. Carotids have no audible bruits. Extremities demonstrate no edema. Neurologic examination is unremarkable. Lipid panel is normal. Magnetic resonance imaging of the brain is normal. Which of the following is the most appropriate next diagnostic procedure?
A. 72-hour Holter monitor
B. Transesophageal echocardiogram
C. Ultrasound of the carotid arteries
D. Ultrasound of the lower extremities
E. Ultrasound of the vertebral artery
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C. Ultrasound of the carotid arteries
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why c? TIA in 30 year old?
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cc is fine but cannt it be b as young person heart disease afib..........i know heart examination normal but so is carotid as no bruit heard
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Generally TIA= atherosclerotic extracranial artery disease
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i think the answer is BBBB
what do u say shuun
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The correct answer is B. Given this person™s young age and presentation, he is most likely to have exhibited signs of a paradoxic embolus that have now resolved. He probably has a patent foramen ovale (PFO). A transesophageal echocardiogram would evaluate effectively this diagnosis while ensuring that bacterial endocarditis is not present.
A 72-hour Holter (choice A) would be useful if the patient were having episodes of lightheadedness, presyncope, syncope, or palpitations.
Ultrasound of the carotid arteries (choice C) would be useful if the patient had symptoms of vision change, persistent weakness, or a cerebrovascular event, to determine if the patient has a partial obstruction in the internal carotid arteries.
Ultrasound of the lower extremities (choice D) would serve to detect deep venous thrombus that may embolize through the (PFO). Diagnosing the PFO is essential, however.
Ultrasound of the vertebral arteries (choice E) evaluates the posterior circulation and is useful when a patient is exhibiting symptoms of cerebellar dysfunction
