Stroke Prevention to Cut or Not?

Abstract

CASE PRESENTATION

The patient, a right-handed 64-year-old pakeha man (New Zealand European), was referred to the neurology clinic in June 2000. His family doctor had discovered bilateral carotid bruits and arranged an ultrasound examination. He was feeling very well; specifically, there were no symptoms of any kind which could be attributed to these bruits – no focal neurological symptoms, or even dizziness or lightheadedness – and he took regular vigorous exercise without difficulty.

Treatment of hypertension had begun more than a decade previously. In 1997 some recordings had been as high as 200/105 mmHg, but at the time of referral his blood pressure was controlled (150/80–90) with Atenolol 50 mg b.d. and Indapamide 2.5 mg daily. His family doctor had started treatment for a total plasma cholesterol of 7.1 mmol/L with Atorvastatin 40 mg daily, subsequently this improved to 5.8 mmol/L, with a total cholesterol/HDL ratio of 3.3. There was no