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