Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 152: A 66-Year-Old with Inability to Speak
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Jun 26, 2025 The hosts dissect a compelling case of a 66-year-old man grappling with speech issues and grip weakness, highlighting the need for comprehensive medical evaluations. They delve into stroke diagnoses, underlining the urgency of treatment as stroke prevalence rises globally. The discussion explores the nuances between transient ischemic attacks and strokes, clarifying common misconceptions. Emphasizing the connection between TIAs and subsequent stroke risk, they stress the importance of early intervention to improve patient outcomes.
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Stroke and TIA Definitions
- Stroke is a clinical diagnosis defined by abrupt neurologic deficits with vascular cause.
- TIA resolves symptoms within 24 hours without brain infarction on imaging; longer symptoms or infarction indicates stroke.
Stroke Risk After TIA
- The 3-month risk of stroke after a TIA is about 10-15%, with most events within 2 days.
- Our patient has a 15-20% stroke risk in the next 3 months, underscoring urgency.
Dual Antiplatelet Therapy for TIA
- Patients with TIA should receive dual antiplatelet therapy with aspirin plus ticagrelor or clopidogrel.
- Ticagrelor is preferred due to more consistent metabolism and fewer genetic variability issues.
