The Curbsiders Internal Medicine Podcast Reboot #164 Stroke and TIA Deconstructed
Aug 16, 2021
01:17:34
Family And DIY Outside Medicine
- Chris Favilla spends most nonwork time with his eight-month-old daughter.
- He also enjoys home renovations despite his wife's mild complaint about time spent.
Recognize TIA By Sudden Focal Deficits
- Think TIA as a sudden, focal neurologic deficit tied to a vascular territory.
- Use sudden onset, focality, and maximal-at-onset timing to suspect TIA over mimics.
TIA Redefined By MRI, Not 24 Hours
- Modern TIA definition is imaging-based, not time-based.
- Diffusion MRI showing infarct converts a clinical TIA into a stroke and predicts higher recurrence risk.
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Introduction
00:00 • 2min
Doctor Cris Favilla - The Guest on the Tonight Show
01:55 • 2min
I'm a Stroke Nerologist, and I'd Love to Renovate My Home for Me.
04:20 • 2min
The Goldfinch by Dona Tar
06:39 • 2min
The Sponsor Job With Indeed Assessments - Get a Full Night's Sleepright
08:17 • 5min
Is It a Homunculus?
13:37 • 2min
Symptoms Last Less Than 24 Hours
15:45 • 5min
Do You Use the A, B, C, D, Squared Score?
20:16 • 2min
Is It a Stroke Recurrence or a B C Squared?
22:02 • 5min
Acute Stroke
26:58 • 2min
Profusion Imaging in Acute Strokes
28:56 • 3min
Is There a Stroke? Or Is It a T I A?
31:33 • 2min
The Hints Exam for Posterior Circulation Strokes
34:02 • 2min
Calo Silicon Rings - The Original Silicon Ring
35:59 • 4min
Is There a Need for a Bubble Study?
40:21 • 2min
Is It a Stroke or a Heart Attack?
42:36 • 2min
Stroke
44:12 • 5min
Do You Have Chronic Micro Vascular Aschemia?
49:28 • 2min
Dosing Aspirant for Long Term Stroke?
51:43 • 5min
Aortic Arch Atheroma
56:22 • 2min
Large Vascular Strokes
58:36 • 4min
Do You Think the Point Trial Is the Best Way to Go About It?
01:02:07 • 2min
Dual Antiplatelets in Large Artery Stenosis?
01:03:57 • 2min
Is There a Relationship Between Chatsto Vask and Stroke?
01:06:21 • 2min
Is Doex a Large Monolith or a Direct Thrombin Inhibitor?
01:08:39 • 4min
Silent Strokes
01:12:29 • 2min
The Curb Siders Podcast - A Little Knowledge Food for Your Brain Hole
01:14:26 • 3min
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!
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
Get a $75 sponsored job credit to upgrade your job post at 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