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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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

Sponsor: Indeed indeed.com/internalmedicine

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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