Stroke Vinod Kurup

Stroke • TIA vs Stroke • Core measures • TPA • Clinical syndromes • CT/MRI tidbits • Quick Neuro exam • Prevention • Why are we admitting patients for this?

TIA vs Stroke • What’s the difference?

TIA vs Stroke • Trick question. • 50 % of patients with TIA have abnl MRI • Need the same diagnostic workup, just without the PT/OT/ST

Stroke • Core measures – Handout – Learn and love them even if they make no sense

TPA • Not a Lazarus effect • Effect is seen at 90 days • Risk of bleeding 0.6 -> 6.4%

Clinical syndromes • http://www.strokecenter.org/professionals/stroke-diagnosis/stroke-syndromes/ • Lacunar • Large vessel

Quick Neuro exam • Mental status – Fluency – Comprehension – Repetition • Visual Fields • Strength – Pronator drift – Fine finger movements – One muscle in each extremity

Quick Neuro exam • Sensory – Skip it (I didn’t tell you that) • Reflexes • Gait – Best test, if you can do it

Prevention • Statin for everybody (just about) • Anticoagulation • Antiplatelet

Prevention • Anticoagulation – A. fib – Cardioembolic source • Thrombus • PFO – Dissection • Vertebral, carotid – Hypercoag states

Prevention • Antiplatelet – ASA, at least 50 mg – Aggrenox better than ASA • 30 % have side effect = – Plavix better than ASA • More bleeding though

Why are we admitting patients? • Find reversible things to prevent next stroke • Prevent complications • Optimize functional status

Admit • Find preventable/reversible things – Tele: Afib (30 day holters?) – Carotid imaging – Cardiac clot or PFO – Education – Monitor sugars – Monitor BPs

Admit • Prevent complications – Permissive Hypertension – DVTs – In big strokes, look for neuro decompensation

Admit • Optimize functional status – PT/OT/ST