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Vinod Kurup
November 18, 2011
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170
Stroke
Quick Primer on Stroke.
Vinod Kurup
November 18, 2011
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Transcript
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