09-11-2007, 03:16 AM
A 79-year-old woman is brought to ER with a suspicion for a cerebrovascular
accident, on her right side She complains of diffuse paresthesias and tingling in her
right hand She did not have loss of consciousness Her speech is normal for age,
deep tendon reflexes are symmetric, 2/4 on both upper extremities, 2/4 both patellar
reflexes, and 0/4 both Achilles reflexes Sensory and rest of the neurological
examination is normal Her right hand is cold and you cannot detect her right arterial
radial pulse Tinel and Phalen's signs are negative What is the most appropriate
next step in the management?
a- Immediate surgery
b- Duplex ultrasound for the arm
c- Angiography
d- tPA
accident, on her right side She complains of diffuse paresthesias and tingling in her
right hand She did not have loss of consciousness Her speech is normal for age,
deep tendon reflexes are symmetric, 2/4 on both upper extremities, 2/4 both patellar
reflexes, and 0/4 both Achilles reflexes Sensory and rest of the neurological
examination is normal Her right hand is cold and you cannot detect her right arterial
radial pulse Tinel and Phalen's signs are negative What is the most appropriate
next step in the management?
a- Immediate surgery
b- Duplex ultrasound for the arm
c- Angiography
d- tPA