Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 169: A 65-Year-Old with Right-Sided Weakness
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Oct 23, 2025 Dr. Andrew Josephson, a renowned neurologist and editor at Harrison's, dives into crucial aspects of stroke diagnosis and management. He explains the significance of rapid evaluation and the FAST acronym for identifying stroke symptoms. Josephson highlights the differences between ischemic and hemorrhagic strokes, and discusses the importance of timely intervention with treatments like alteplase (TPA). He also shares insights on endovascular therapy advancements and emphasizes public education on stroke awareness to improve emergency responses and outcomes.
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Real-World FAST Recognition
- A 65-year-old man with CAD, HTN, HLD, and diabetes acutely developed right facial droop, right hemiplegia, and speech disturbance at work.
- Colleagues recognized FAST signs and he arrived at the ED in under one hour for urgent evaluation.
Give IV Alteplase Quickly If Eligible
- With acute ischemic stroke and no hemorrhage on CT, give intravenous alteplase if within 4.5 hours and no contraindications.
- Confirm absence of anticoagulation or bleeding diathesis and act quickly to administer TPA.
CT To Differentiate Ischemic From Hemorrhagic Stroke
- About 75% of strokes are ischemic and 25% hemorrhagic, so acute CT is essential to exclude hemorrhage.
- Rapid neuroimaging guides whether thrombolytic or other interventions are safe.
