Stroke

Be1ad39c553a50569c138e673a19cbff?s=47 Vinod Kurup
November 18, 2011
43

 Stroke

Quick Primer on Stroke.

Be1ad39c553a50569c138e673a19cbff?s=128

Vinod Kurup

November 18, 2011
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Transcript

  1. 2.

    Stroke • TIA vs Stroke • Core measures • TPA

    • Clinical syndromes • CT/MRI tidbits • Quick Neuro exam • Prevention • Why are we admitting patients for this?
  2. 4.

    TIA vs Stroke • Trick question. • 50 % of

    patients with TIA have abnl MRI • Need the same diagnostic workup, just without the PT/OT/ST
  3. 5.
  4. 6.

    TPA • Not a Lazarus effect • Effect is seen

    at 90 days • Risk of bleeding 0.6 -> 6.4%
  5. 8.

    Quick Neuro exam • Mental status – Fluency – Comprehension

    – Repetition • Visual Fields • Strength – Pronator drift – Fine finger movements – One muscle in each extremity
  6. 9.

    Quick Neuro exam • Sensory – Skip it (I didn’t

    tell you that) • Reflexes • Gait – Best test, if you can do it
  7. 11.

    Prevention • Anticoagulation – A. fib – Cardioembolic source •

    Thrombus • PFO – Dissection • Vertebral, carotid – Hypercoag states
  8. 12.

    Prevention • Antiplatelet – ASA, at least 50 mg –

    Aggrenox better than ASA • 30 % have side effect = – Plavix better than ASA • More bleeding though
  9. 13.

    Why are we admitting patients? • Find reversible things to

    prevent next stroke • Prevent complications • Optimize functional status
  10. 14.

    Admit • Find preventable/reversible things – Tele: Afib (30 day

    holters?) – Carotid imaging – Cardiac clot or PFO – Education – Monitor sugars – Monitor BPs
  11. 15.

    Admit • Prevent complications – Permissive Hypertension – DVTs –

    In big strokes, look for neuro decompensation