About this episode
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! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com 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 Sponsor: Indeed indeed.com/internalmedicine Get a $75 sponsored job credit to upgrade your job post at Indeed.com/internalmedicine . Sponsor: Qalo qalo.com/curb Head to qalo.com/curb to get 20% off your purchase today. 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