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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Aug 5, 2019

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! ACP members can claim CME-MOC credit at (CME goes live at 0900 ET on the episode’s release date). 

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  • Producers: Molly Heublein MD; Matthew Watto MD, FACP
  • Writer (including CME questions): Molly Heublein MD
  • Cover Art: Bryan Brown MD
  • Hosts: Stuart Bringham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  • Editor: Emi Okamoto, MD; Matthew Watto MD, FACP
  • Guest: Chris Favilla, MD

Time Stamps

  • 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