Repeated attacks of LOC and TIA (344/1700)

A 68yo man gets repeated attacks of LOC and TIA. What is the most likely cause for this?
a. Atrial fib
b. Mitral stenosis
c. Aortic stenosis
d. HOCM
e. Carotid artery stenosis




























answer: E

Presentation

• Patients may present with TIAs or CVEs.
• Typical symptoms are contralateral weakness or sensory disturbance, ipsilateral loss of vision, and (if the dominant hemisphere is involved) dysphasia, aphasia or speech apraxia.
• Cognitive impairment and decline may be associated with asymptomatic stenosis of the left internal carotid artery.

Signs

• Detection of a carotid bruit is a common physical examination finding that may lead to a referral for carotid duplex ultrasound.
• Carotid bruits are not sensitive or specific enough to confirm or exclude significant carotid stenoses. Absence of carotid bruit in patients with cardiovascular disease does not exclude a carotid stenosis.

Investigations

Colour duplex ultrasound

Treatment

Carotid endarterectomy (surgical removal of the fatty deposits and blood clots from inside the carotid artery wall