Unknown If YES, migraine(s) with aura: Yes Unknown No Carotid stenosis: Yes Unknown No Carotid endarterectomy: Yes Unknown No If YES, indicate location: Left side Both Right side Unknown Carotid artery stenting: Yes Unknown No If YES, indicate location: Left side Both Right side Unknown Seizure episode: Yes Unknown No Epilepsy/ Seizure disorder: Yes Unknown No Central nervous system infection: Yes Unknown No Dementia: Yes Unknown No Current clinical depression: Yes Unknown No Depressive disorder diagnosis: Yes Unknown No If YES, age experienced first depressive episode/ diagnosed with depression (years): Current clinical anxiety: Yes Unknown No Anxiety disorder diagnosis: Yes Unknown No Psychotic disorder: Yes Unknown No
Unknown If YES, migraine(s) with aura: Yes No Unknown Carotid stenosis: Yes No Unknown Carotid endarterectomy: Yes No Unknown If YES, indicate location: Left side Right side Both Unknown Carotid artery stenting: Yes No Unknown If YES, indicate location: Left side Right side Both Unknown Seizure episode: Yes No Unknown Epilepsy/ Seizure disorder: Yes No Unknown Central nervous system infection: Yes No Unknown Dementia: Yes No Unknown Current clinical depression: Yes No Unknown Depressive disorder diagnosis: Yes No Unknown If YES, age experienced first depressive episode/ diagnosed with depression (years): Current clinical anxiety: Yes No Unknown Anxiety disorder diagnosis: Yes No Unknown Psychotic disorder: Yes No Unknown
F1152_Medical_History.docx