A 57-Year-Old Woman Comes to the Emergency Department Due to Difficulty

A 57-year-old woman comes to the emergency department due to difficulty speaking.  Two hours ago, the patient was on the phone, at work, arguing with her daughter when she suddenly could not find her words.  She had to end the call and then could not explain to co-workers what was wrong.  The patient also noticed some weakness in her right arm.  Her symptoms resolved on the way to the emergency department.  She has not had similar symptoms before.  Medical history includes hypertension and type 2 diabetes mellitus.  Temperature is 37.2 C (99 F) , blood pressure is 155/90 mm Hg, pulse is 89/min, and respirations are 14/min.  Complete neurologic examination shows no abnormalities.  Blood glucose is normal.  Noncontrast head CT scan is normal.  The patient feels "back to normal" and requests to be discharged home.  Which of the following is the most appropriate response by the physician?

A) "Because your examination and imaging are normal, you can be safely discharged.  You should follow up with a neurologist within the month."
B) "Because your examination and imaging are normal, your symptoms were likely due to stress.  No further workup is required."
C) "Despite a normal examination and imaging, a repeat CT scan in 6 hours is required to confirm that your symptoms were not due to a stroke."
D) "Despite a normal examination and imaging, you are having a stroke and your symptoms will likely return without thrombolysis."
E) "Despite a normal examination and imaging, you have an increased risk of stroke in the next few days and should have further testing."