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!
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
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
