Stroke

Transcript

1. 1.

   Stroke Vinod Kurup

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   Stroke • TIA vs Stroke • Core measures • TPA

   • Clinical syndromes • CT/MRI tidbits • Quick Neuro exam • Prevention • Why are we admitting patients for this?
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   TIA vs Stroke • What’s the difference?

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   TIA vs Stroke • Trick question. • 50 % of

   patients with TIA have abnl MRI • Need the same diagnostic workup, just without the PT/OT/ST
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   Stroke • Core measures – Handout – Learn and love

   them even if they make no sense
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   TPA • Not a Lazarus effect • Effect is seen

   at 90 days • Risk of bleeding 0.6 -> 6.4%
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   Clinical syndromes • http://www.strokecenter.org/professionals/stroke-diagnosis/stroke-syndromes/ • Lacunar • Large vessel

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   Quick Neuro exam • Mental status – Fluency – Comprehension

   – Repetition • Visual Fields • Strength – Pronator drift – Fine finger movements – One muscle in each extremity
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   Quick Neuro exam • Sensory – Skip it (I didn’t

   tell you that) • Reflexes • Gait – Best test, if you can do it
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    Prevention • Statin for everybody (just about) • Anticoagulation •

    Antiplatelet
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    Prevention • Anticoagulation – A. fib – Cardioembolic source •

    Thrombus • PFO – Dissection • Vertebral, carotid – Hypercoag states
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    Prevention • Antiplatelet – ASA, at least 50 mg –

    Aggrenox better than ASA • 30 % have side effect = – Plavix better than ASA • More bleeding though
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    Why are we admitting patients? • Find reversible things to

    prevent next stroke • Prevent complications • Optimize functional status
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    Admit • Find preventable/reversible things – Tele: Afib (30 day

    holters?) – Carotid imaging – Cardiac clot or PFO – Education – Monitor sugars – Monitor BPs
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    Admit • Prevent complications – Permissive Hypertension – DVTs –

    In big strokes, look for neuro decompensation
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    Admit • Optimize functional status – PT/OT/ST