Cerebrovascular cases.

Abstract

Five cases are presented illustrating some of the investigative and therapeutic dilemmas faced when treating patients with cerebrovascular disease in the outpatient clinic. The results of some recent major randomized controlled trials are applied to assist the decision-making process for individual patients. The investigation and management of patients with minor stroke or transient ischemic attack, and symptomatic or asymptomatic carotid stenosis are discussed. Issues raised include the role of angiography versus noninvasive imaging, carotid endarterectomy versus carotid stenting, and how to apply new evidence regarding antihypertensive and lipid-lowering therapy to patient management. The role of thrombolysis for acute stroke is discussed, and the work-up of a patient with attacks of dizziness and a patient with atypical headache are also presented.