78yo F w/ large R MCA stroke, cardioembolic 2/2 a fib.
Dr. Joshua Willey | Morning Report | 05/25/2017
"Fall risk" is not always a legitimate reason not to use anticoagulation for stroke prevention in A fib. One study showed you need to fall about 150 times a year to justify not putting a patient on coumadin due to fall risk.
Posted 05/25/17 02:58:10 PM by Emily Miller
Use clinical signs as a way to triage the likely size of a CVA, single lobe vs. multilobar. Gaze deviation = frontal lobe. Motor weakness = frontal and parietal lobes. Dysarthria = temporal lobe. if 3 lobes are involved, stroke will likely be very disabling.
Posted 05/25/17 03:00:27 PM by Emily Miller
Risk of mass effect and hemorrhagic conversion post CVA peaks at day 2-3. Don't wait for blown pupil or signs of herniation to suspect. If patient is sleepy w/ more than 50% cerebral involvement on imaging, they would likely benefit from prophylactic hemicraniotomy (NNT = 2!)
Posted 05/25/17 03:02:16 PM by Emily Miller
Typically wait 2-4 weeks prior to starting anticoagulation for secondary stroke prevention after CVA.