Outpatient management of transient ischaemic attack

Abstract

Mr Chong, a 63-year-old retired, right-handed Chinese man, hurriedly walked over to your clinic after feeling a sudden, transient episode of weakness in his left arm and face. He had noticed the weakness on waking that morning. At first, he could hardly raise his shoulder, and was only able to move his fingers with great difficulty. About 15 minutes later, while trying to get dressed, he noticed the strength in his arm returning and his face returning to normal. He had been on amlodipine for hypertension and simvastatin for hyperlipidaemia over the past two years, and had been smoking for the past ten years. He apologetically admitted that he had run out of medication two weeks ago. His blood pressure was 170/100 mmHg and his heart rate was regular at 88 beats/min. You noted that his speech was clear and gait normal. On further neurological examination, neither upper or lower limb weakness nor numbness was detected bilaterally, and there were no signs of cerebellar dysfunction.