TIA and Carotid Disease — Clinical Case

DCE Long Case

Patient brief

Patient: Mr Alan Wright, 71 years old. ^[6]

Presenting complaint: At 08:00 he developed sudden right-face droop, right-arm weakness and difficulty finding words lasting 20 minutes, fully resolved by 08:30. He presents at 11:00 feeling back to normal but frightened. ^[9]

Past history:

• Type 2 diabetes
• Hypertension
• Hyperlipidaemia
• Ex-smoker (restarted recently)
• No known AF ^[7]

Medications: Metformin, perindopril, atorvastatin (intermittent adherence). No antiplatelet currently. ^[7]

Examination: BP 168/92, HR 78 regular, neurologically normal, soft left carotid bruit, no murmurs. ^[6]

Investigations so far: Non-contrast CT brain — no haemorrhage. ECG sinus. Capillary glucose 9.1. ^[6]

Tasks

1. Present a problem list and urgent management plan. ^[5]
2. Explain antithrombotic choices and duration. ^{[2] [3]}
3. Outline carotid imaging and revascularisation thresholds. ^[8]

Model discussion points

Problem list: high-risk TIA (cortical features); uncontrolled vascular risk factors; possible symptomatic carotid disease; medication non-adherence; driving and safety counselling needs. ^{[1] [7]}

Plan: urgent stroke/TIA pathway; short DAPT if non-cardioembolic; same-day/urgent carotid imaging; rhythm monitoring; high-intensity statin and BP plan; smoking cessation; educate on recurrence symptoms. ^{[2] [5] [7]}

If ipsilateral 70–99% stenosis: urgent CEA/CAS referral plus continued medical therapy. ^{[8] [4]}