Transient Ischemic Attack
Age: years old
Gender:
HISTORY:
Presents with a - history of side
Onset was , started
Symptoms include:
, , , ,
Contributing factors:
no history of: , , , , ,
no use of: , ,
EXAM:
General appearance: ,
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Neck: , , , c-spine
Heart: , ,
Lungs: , ,
Extremities: , , cap refill sec, pulses , ,
Neurologic:
- Mental status: , oriented to , speech
- Cranial nerves:
- Strength: except for on ,
- Sensation: to on
- Reflexes: except for on ,
- Cerebellar function: , finger-nose, rapid alternating movements, heel-shin, Romberg , Dix-Hallpike
- Gait: , tandem gait, heel walk and toe walk
ASSESSMENT:
DDx: ischemic stroke, hemorrhagic stroke, seizure, hypoglycemia, complex migraine, migraine with aura, transient global amnesia, syncope, drug intoxication, posterior circulation ischemia, arterial dissection, vasculitis, hypertensive encephalopathy, cardiac arrhythmia, carotid stenosis, retinal artery occlusion, atrial fibrillation, patent foramen ovale, hypercoagulable states, syncope, drug intoxication, posterior circulation ischemia, arterial dissection, vasculitis, hypertensive encephalopathy
PLAN:
Investigations:
- Blood work: , , , , , , ,
- ECG
- CT scan of the head
- MRI of the head
- Carotid ultrasound
- Holter monitor
- Echocardiogram
Treatments:
-
-
-
- Lifestyle modifications: smoking cessation, weight loss, exercise, healthy diet
Further care:
- Referral to neurologist
- Follow-up in
- Return if symptoms worsen or if new symptoms develop such as severe headache, sudden vision changes, or sudden weakness or numbness
HISTORY: EXAM: Neurologic: ASSESSMENT: PLAN: