65 years old right handed man started to have some numbness and tingling sensation in the right face, arm and leg, which started at 8AM today after the breakfast. He also has some slurred speech and some clumsy in the right hand. He also has had some headache in the left temporal area since last night.
He was told that he has HTN and DM, but he has not seen a physician for the past 10 years. He smokes 2 parks a day, no ETOH and drug use. Parents died at age of 90s. He is not taking any medications at home.
When he arrived at ED at 10 AM, the numbness and tingling sensation as well slurred speech were gone around 9:30 AM, but still has mild headache, which is not bothering him.
At Emergency room, BP 165/99, HR 72, AAOx3, language is fluent. He has no focal neurological deficits: no facial droop, numbness or weakness, he walks normally.
Lab: CBC was normal, BUN 12, Cr 1.1, INR 1.0, Glucose 259,
Head CT: unremarkable, no acute change.
What is the next step:
- Tell patient: every thing looks good, you can go home now,
- Discharge him to home with ASA and follow up with his primary care physician,
- Admit patient to hospital for further TIA workup,
- Give patient ASA, and hold patient at ED: order brain MRI, carotid utrasound, echocardiogram, HA1c, and Lipid profie,
- Patient has acute ischemic stroke, give patient IV tPA immediately,
- Transfer patient to a big medical center, because he has acute stroke.
