"I would then take a complete history from the patient. I want to characterize the patient's complaint, ask about associated symptoms, and elicit risk factors from the patient's history."
• Associated symptoms:
o Neurologic: Mental status changes, headache, weakness/paralysis, numbness/tingling, dizziness/syncope, dysphasia, dysphagia
o Visual: Scotomas, aura, photophobia, eye pain
o Constitutional: Fever, chills, nausea/vomiting, pain
o Cardiovascular: Palpitations, chest pain, claudication
o Psych: Anxiety, panic attacks, drug use
- PMH: Stroke, TIA, cardiovascular disease (a-fib, HTN, DM, CAD); peripheral vascular disease (PAD, atherosclerosis, aneurysms, DVTs); neurologic disease (migraines, seizures, malignancy); hypercoagulable states (Factor V Leiden deficiency, malignancy); bleeding disorder
- PSH: Carotid surgery (carotid endarterectomy, carotid stents), coronary artery bypass graft, coronary angioplasty/stenting, peripheral arterial bypass
• Neurological (Full exam): Mental status, cranial nerves, motor/strength, reflexes, coordination, sensory, and gait exam.
•Cardiac: Rate, rhythm (regular vs irregular important), murmurs/rubs/gallops
• Vascular: Inspect extremities (cyanosis, clubbing, pallor, rubor), Palpate all peripheral pulses, looking for irregular, asymmetric, or weak pulses, Carotid, radial, femoral, popliteal, posterior tibial, dorsalis pedis, Auscultate for bruits (especially along carotid arteries)
• Ophthalmologic: Hollenhorst plaques (cholesterol emboli), hypertensive retinopathy