Hot Topics in Stroke

1
Hot Topics in Stroke

• Seemant Chaturvedi MD, FAHA, FAAN
• Professor of Neurology
• Director, WSU/DMC Stroke Program

2
Case 1

• A 70 year old man with history of HTN and DM
  presents with 3 episodes of right arm weakness
  and speech difficulty lasting 5-10 minutes each
• No history of A FIB, CHD
• Takes aspirin irregularly for joint pain
• Quit smoking 30 yrs ago

3
Case 1-2

• BP 160/80
• In NSR
• Neuro exam negative for focal abnormalities
• Bilateral carotid bruits
• Cr 1.2
• Chol 210 LDL 120 HDL 40

4
Case 1-3

• What is the ABCD score?
• What if this patient has gt50 carotid stenosis?
• What is the role for carotid stenting vs. CEA?
• What if there is no carotid stenosis but the
  patient has A FIB?

5
Case 2

• A 78 year old woman comes in for routine PE and
  is noticed to have a right carotid bruit
• History of inferior MI 5 yrs previously
• No history of DM, smoking
• On meds for HTN, hyperlipidemia

6
Case 2-2

• Carotid duplex shows 80 stenosis on the right,
  lt50 stenosis on the left
• BP 138/80
• Total chol 150 LDL 85 HDL 52

7
Case 2-3

• What is the role for carotid intervention in
  asymptomatic patients?
• What is the role for carotid intervention in
  elderly patients?
• Is there a difference between men and women?

8
Case 3

• A 58 year old man is exercising in the health
  club
• He develops sudden onset of right hemiplegia,
  expressive aphasia
• PMH Aortic stenosis
• Not taking any regular medications

9
Case 3-2

• The patient is taken to the closest ER
• BP 160/80
• In NSR
• PE confirms moderate expressive and receptive
  aphasia, weakness involving right face/arm/leg
• NIHSS 14
• CT done 90 mins after symptom onset negative for
  hemorrhage

10
Case 3-3

• What is the role for thrombolysis for acute
  stroke?
• Are there interventional treatment approaches?
• Should patients be diverted to certified Stroke
  Centers?