You are assessing a 65 year old lady who has been referred by the stroke team for an episode of TIA (Rt arm and leg weakness that completely recovered ). She has history of undergoing a thyroidectomy 10 year ago for multi nodular goitre.
Discuss what investigations you would request and why.
Discuss your consent process
Investigations I would request:
1. CTA
2. Cardiac assessment
3. Neurological assessment
4. Assessment of access vessels (femoral a.)
The consent process should include discussion about available options for treatment and potential hazards of open surgery as nerve injury, cerebral stroke and bleeding risks.
Discuss what investigations you would request and why.
I will ask for carotid doppler if it shows more than 50% stenosis another carotid doppler should be considered or CTA then CEA or CAS should be considered
Discuss your consent process
I will discuss the possibility of peri operative stroke – risk of nerve injury which will increase due to redo surgery- possibility of hematoma infection
first, I will request carotid duplex, if stenosis more than 50% I will confirm this either by CTA , or another duplex but with different operator. If the patient is candidate for carotid intervention and fit for carotid endarterectomy, I agree with Dr Eman as I must confirm that the recurrent laryngeal nerve wasn’t been injured during thyroidectomy.
during consent process, I will discuss with the patient the common complications of CEA adding to this I will mention that, the possibility of cranial nerve injury may be higher in her case because it is a redo surgery.
1 upper laryngeoscope to check mobility of vocal cord
2 consent of trscheostomy
Investigations I would request:
1. CTA
2. Cardiac assessment
3. Neurological assessment
4. Assessment of access vessels (femoral a.)
The consent process should include discussion about available options for treatment and potential hazards of open surgery as nerve injury, cerebral stroke and bleeding risks.
Q1 Full labs include TSH T3 T4
Repeat carotid duplex or CTA
Cardiac assessment
ENT referal for assessement focal cords due to possibility of nerve injury during previous thyridectomy .
Q2. Pt has TIA so he need crotid revascularization to prevent further TIA or strokes but he has hostile neck so he has risk of CNI during CEA, long operation procedure, infection, iatrogenic injury to surrounded structures but all these risks will decrease by CAS that increase risk of perioperative stroke.
thank you for your excellent response. it is a redo surgery rather than a hostile neck, particularly with benign disease.