The Curbsiders Internal Medicine Podcast16 Aug 2021

Reboot #164 Stroke and TIA Deconstructed

Enjoy this Curbsiders classic and stay tuned this Wednesday, August 18, 2021 for a brand new Stroke and TIA Triple Distilled episode.
Update your management of stroke and TIA in primary care. Stroke neurologist, Chris Favilla MD (University of Pennsylvania), walks us through the plumbing of the brain, so we can identify ischemic risks in stroke and TIA patients to prevent recurrences. Learn factors that make a TIA high risk, which imaging studies to order, new research around aspirin dosing, dual antiplatelets, DOACs, cardiac monitoring and more!
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ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders

Credits

Producers: Molly Heublein MD; Matthew Watto MD, FACP
Writer (including CME questions): Molly Heublein MD
Cover Art: Bryan Brown MD
Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Emi Okamoto, MD; Matthew Watto MD, FACP
Guest: Chris Favilla, MD

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Time Stamps* Time Stamps refer to ad-free version

00:00 Intro, disclaimer, guest bio, and a bad pun
04:20 Chris’ one-liner, advice as a teacher, book recommendation -The Goldfinch,
07:40 Molly’s pick of the week -Extreme Measures (book) by Jessica Zitter
08:40 A case of TIA; definition of TIA
12:14 Stroke territories
14:24 New definition of TIA
16:00 Differentiation from complex migraine
19:17 Risk stratifying TIA and ABCD2 score
22:00 A bit on tPA
24:01 Workup for TIA; workup for amaurosis fugax
25:36 CNS imaging studies after stroke or TIA; Choice of imaging study
33:15 HINTS exam for posterior circulation stroke
34:48 Is an echo necessary? Bubble study for PFO?
38:32 Duration of afib monitoring
40:24 Echo reports: what to look for in patient with stroke or TIA; “soft markers”
41:55 Blood testing after Stroke and TIA (lipid panel, HbA1C; +/- RPR, coags, CBC)
43:50 Folic acid; Sparkle trial: high dose atorvastatin versus placebo for secondary prevention
47:00 Incidental finding: multiple patchy infiltrates in a patient without stroke or TIA; Is it significant?
48:50 Aspirin therapy after TIA; Dosage adjustment based on weight?
51:10 A case of stroke; TOAST trial and classification of acute stroke; ESUS; aortic arch atheromas
55:58 Large artery strokes (hypoperfusion, acute thrombosis, artery to artery embolization)
57:15 Antiplatelets after stroke and TIA; DAPT and duration of therapy
62:57 Antidiabetic drugs and stroke
63:40 Lightning round: CHA2DS2VASc score and women; how much afib is significant?; 66:32 Are all DOACs created equal?; 68:20 Regaining function after a stroke; 69:47 Silent infarcts on imaging
71:54 Resources for stroke: Decision making in neurology textbook
73:28 Outro

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