124 Strokes and TIAs

Hello, and welcome to the Physician Assistant Exam Review Podcast. My name is Brian Wallace. I’m the host and creator here at Physician Assistant Exam Review, and it has been almost a year since I released the last podcast, and I can’t be more excited than to be back with you today. So I looked up and realized that the last podcast I released was back in January of 2024, but that was an interview I did with a previous student, not really a content specific podcast like I’ve traditionally been doing here behind the microphone. So it occurred to me that I needed to get another episode out in 2024 for you. I absolutely love doing the podcast. It is a ton of fun, but as you know, it’s a lot of work to put the information together, to do this, to sit down and put it together.

And I’ve been doing so much else this year. So many other things, so many other great opportunities have come up for me at Physician Assistant Exam Review. For example, I have been traveling to different PA programs around the country. Helping students in live workshops, helping students one-on-one, helping faculty develop curriculum around the things that I teach, around the things that they’re doing. And the biggest one, though, the most thing that takes the majority of my time is the 33 Days program, which you may or may not be aware of, but is sort of the boot camp program I run about four times a year. This year it was five times because of demand. Quite honestly, people were reaching out asking me to run another one.

And it’s a boot camp I run for preparation for the PANCE, but really it’s to teach the different skills that we cover at Physician Assistant Exam Review. It’s to teach things like advanced study techniques, test taking approach and skills, anxiety management, peak performance for exam day. All these things that go into creating the best possible student to show up on exam day to take their test. And I’ve been able to see just miraculous scores come across the board. In fact, I had someone just this morning email me. I can’t remember if they’re on their second or third PANCE attempt, but they went up 44 points to finally pass the PANCE after going through the 33 Days program. The November program was really exciting to get that email with someone who worked particularly hard, showed up at every meeting, asked questions, did everything that she could.

And I was really pulling for her because I knew the work that she’d put in and I wanted to see that pay off for her and it did and it was really, really exciting. So, anyway, that’s a lot of what I’ve been up to for the past year, but I realized I needed to get back here, back to what launched Physician Assistant Exam Review and move forward with some of the content, but with some of the new ideas and techniques and ways of dealing with material that I’ve come across and moved into and developed over the past year. And after working so closely with so many different students and so many different faculty and different PA programs and really dialing in some methods and some techniques to help with retention, to help boost scores, to help students become the students they want to be, and then eventually pass PA school the PANCE and move out into the world and become amazing practitioners. Really, that’s our goal, right? So with all of that said, I’m going to jump in and just get started in today’s episode. Episode 124, we’re going to pick up right where I left off a year ago in the middle of neurology because I couldn’t think of a better way to handle it. So I thought, well, let’s just pick up here and we’re going to keep it moving.

One thing I am going to let you know about, though, is I plan on releasing a podcast every week throughout 2025 starting right now. So please make sure that you tune in next week. And what’s going to happen is those are going to be companion episodes. And you’ll see how that’s going to work. It’s going to be really exciting. A lot of fun. I started putting it together and I’m very excited with how that’s going to work out.

So make sure you not only tune in this week, but be prepared because there is a new show coming next week and the week after and the week after that.

Okay, so today we’re going to be covering transient ischemic attacks, hemorrhagic and ischemic strokes. And we cover these together because they sort of go together, right? When you learn these, you want to learn things in groups, learn things in how they’re going to come, how their symptoms are going to present, both on your exam and in the clinic. So, if you have somebody show up in your clinic, a TIA and a stroke are going to look kind of similar, right? And ischemic stroke and hemorrhagic stroke are going to look kind of similar. Similarly, on your test, you’re going to get test questions that are going to pose these as the possible answer choices or somehow you’re going to differentiate between the two or between the treatments for them. And that’s going to be how that question is going to come, right?

I always joke around with students. You’re not going to get a question that’s going to ask about someone with symptoms of a stroke and the answer choices are going to be a TIA, hemorrhagic stroke, ischemic stroke, and bronchitis, right? You’re not going to see that. That’s not how it works. You’re going to have to differentiate these from each other. So just to make sure we’re all on the same page, a stroke is a sudden interruption of blood flow to the brain that leads to brain cell damage and potential loss of neurological function. It occurs when a blood vessels in the brain becomes blocked, ischemic stroke, or ruptures, hemorrhagic stroke.

So, either either we get blocked blood flow, which kills off brain tissue, or we get a bleed in the brain and the blood flow goes out of the vessels and due to pressure and to the lack of blood supply to those to where it’s supposed to go, we get neurologic dysfunction. A TIA, a transient ischemic attack, it’s kind of like a mini stroke. It has the same symptoms as a stroke, but they don’t last as long. There’s no lasting tissue damage here, and the symptoms typically resolve within about 24 hours.

All right, let’s jump in with our priming questions.

Now, you may have just listened to the last episode, but it’s been over a year since I recorded it, so really quick, I want to go over what priming questions are. Priming questions. These are short, tight questions that I put at the front of every episode, and the reason I do that is because there’s a ton of literature out there that says that, well, one, if you participate rather than just listen, your retention skyrockets, right? If you’re engaged with the material, if you’re thinking, if you’re organizing, if you’re moving with the material, your retention goes through the roof. So we focus a lot on this podcast throughout Physician Assistant Exam Review on engagement. I don’t just want you sitting there listening to the podcast while you’re out for a walk or whatever you’re doing, driving along, daydreaming, and the information goes in one ear and out the other. That’s kind of a waste of time.

You might as well be listening to music. In fact, I would prefer that. At least that’s more entertaining, right? I want you to be, though, if you want to get something out of this, though, I want you to be engaged. I want you to be participating mentally. And there’s a big difference in your results if you do that. The priming questions are to get the brain thinking in the right direction, to get it moving.

It’s almost like building the shelves. You’re going to put the books on that are going to hold all the information, right? And that’s what we’re doing here. So even if you don’t know the answers, it’s important to your retention that you pay attention and that you try. There’s a myth out there with students, and I was the same way in school, and I think everyone tends to be, is that you don’t want to learn the wrong thing. You don’t want to think about the wrong thing because that might be what sticks. That’s not what the data bears out.

The data bears out that trying, even if you get it wrong, is incredibly valuable for then creating these little hooks or bookshelves for you to store the information on as it comes in. So my strong advice to you is to go ahead and try these along with us, regardless of where you find yourself.

All right, so let’s get started. Which medication is commonly used to reduce intracranial pressure in a hemorrhagic stroke? Which medication is commonly used to reduce intracranial pressure in a hemorrhagic stroke? What is the typical time window for administering TPA in an acute ischemic stroke? What is the typical time window for administering TPA in an acute ischemic stroke? In a patient with a TIA from a cardioembolic source, what category of medication is typically indicated? In a patient with a TIA from a cardioembolic source, what category of medication is typically indicated?

What systolic blood pressure target is recommended for acute management of hemorrhagic stroke? What systolic blood pressure target is recommended for acute management of hemorrhagic stroke?

All right. Well, let’s see if we can get some of these answered for you, but we’re going to go through in detail the things you need to know and do my best, my very best, to cut out all of the noise and present you with as much signal, as much information that’s going to help you get through your exams, answer the most questions, and retain the most information. So we’re going to start with hemorrhagic stroke. A hemorrhagic stroke is when blood vessels in the brain rupture leading to bleeding in the surrounding brain tissue, right? Pretty straightforward hemorrhagic stroke. This is only 15% of all strokes, but it has a much higher mortality than ischemic strokes, right? So it’s a much higher mortality, even though it’s only about 15% of strokes.

How do patients present? Well, for one thing, it’s sudden onset of symptoms. You can kind of picture that. Symptoms may include headache. We often talk about the worst headache of your life, that thunderclap headache. This is associated with a subarachnoid hemorrhage, so that sort of helps you discern where the bleed is. But it’s that worst headache of your life, it’s a hemorrhagic stroke.

These will often be accompanied with nausea and vomiting due to increased intracranial pressure. Obviously, you’re going to get neurologic deficits. These are going to have contralateral hemiparesis, sensory deficits, facial weakness, and among other things. You can also get altered mental status, which goes from confusion to coma. You can get seizures, nystagmus, visual field defects, aphasia, and loss of consciousness in severe cases.

Now, how are we going to discern these? How are we going to tell what’s going on here? Well, lab studies and physical exam findings. We’re going to start with physical exam findings. So you’re going to check a blood pressure when somebody comes through the door because obviously that’s going to be something we’re extremely concerned about with a hemorrhagic stroke. You’re going to assess Glasgow’s coma scale for neurological function. And this is one that’s probably worth memorizing.

It’s not that difficult, but this is just going to be straight memorization. The scores range from 3 to 15. With mild impairment being a 13 to 15, moderate impairment being a 9 to 12, severe impairment or coma being less than 8. And you get points for different activities. So eye-opening, if they can do it spontaneously, they get four points. If they do not open their eyes at all, it’s no points. A verbal response, I’m sorry, eye-opening goes down to one point.

So the scale goes from three to 15. So you get one point minimum for all of these things. So if they don’t open it spontaneously, it’s one point. If they can open spontaneously, it’s four points. Verbal responses, if they’re oriented to person, place and time, it’s a five, no response is a one, and then we’re going to range in between there. Motor responses, if they can obey commands, it’s a six, down to a one if they can’t follow any commands, right? And then we’re going to gauge in between there.

So again, mild impairment was a 13 to a 15, moderate was a nine to 12, and then severe impairment or coma was less than an eight, less than or equal to eight. You’re probably going to get some blood work on these patients, so you’re going to do a PT, PTT, and INR, a CBC, and a CMP just to see what’s going on. They come in with these symptoms, right? You’re going to want to check on what’s happening. Imaging. Non-contrast CT is the first line of test and identify intracranial bleeding. An MRI is used for chronic hemorrhages or to evaluate further.

You don’t have to keep an eye on and follow these up. Angiography is necessary if you think there may be an AVM, arteriovenous malformation, or if you think an aneurysm might be suspected. Well, let’s slow down for just a second. What’s an AVM? An AVM is an abnormal connection between arteries and veins. So it’s where the arteries and the veins connect directly. There’s no capillary bed.

That’s what an AVM is. So you can have problems there where it can lead to these hemorrhages because you get high pressure going into low pressure directly without any step down. An aneurysm is an outward bulging like a balloon or a bubble caused by a weak wall in the arterial walls that can also then rupture when there’s a lot of pressure when there’s more pressure than normal or just when that bubble becomes even weaker. A lumbar puncture is going to be on your list of things to do for these patients because it’s indicated if you suspect a subarachnoid hemorrhage but the CT is negative. A lumbar puncture will help to demonstrate that. And what you’ll see is a yellow discoloration of the cerebral spinal fluid due to bilirubin, and that’s called xanthochromia. You can get elevated opening pressures, which indicate increased intracranial pressures as well.

So those are things to note for a lumbar puncture that you might do for a hemorrhagic stroke. Treatments. Well, first you’re going to start off with medical management, which is going to be we want to lower the intracranial pressure. Here you’re going to use mannitol or hypertonic solid. Not hypertonic solid, sorry, hypertonic saline. Blood pressure control. You’re going to target a BP below 140, right?

We want to be under 140, systolic under 140. Then we’re going to reverse any anticoagulation because obviously if we have a hemorrhagic stroke, we don’t want to be, we want to let the coagulation cascade kick in. We don’t want to be fighting it. Surgical management. If the medical management isn’t functioning or isn’t enough, you can do a craniotomy for large bleeds or herniation risk. We can go in and clip and coil for ruptured aneurysms.

All right. So now let’s talk about ischemic strokes. These are due to obstruction of blood flow and they account for about 85% of strokes. So this is the vast majority, but again, they are less deadly, I guess is not the best way to say, but that’s what we’re going to go with. Clinical presentation. You get sudden onset of neurological deficits dependent on the affected area of the brain. So you get motor deficits, contralateral hemiplegia or hemiparesis, sensory deficits, contralateral numbness or loss of sensation.

You can get speech disturbances, aphasia or dysarthria, which is a motor speech impairment. Vision changes like amaurosis fugax or diplopia or visual field defects, cognitive mental status changes like confusion, disorientation, coordination and balance issues like ataxia and vertigo and symptoms. But here’s the kicker. Symptoms tend to be unilateral. But in general, the symptoms also tend to be very similar to a hemorrhagic stroke, right? So, it’s hard to tell them apart that you’re and that’s really what one of the things you’re trying to do in this section is to determine the difference when a patient walks through the door or test question is it hemorrhagic or is it ischemic? And the nausea and vomiting associated with a hemorrhagic stroke might be helpful.

The worst headache of my life with the hemorrhagic stroke is helpful, but after that, it starts to blur a little bit and become a little bit more difficult.

So let’s talk about the the imaging we’re going to do is going to be very similar, right? It’s going to be the same because we don’t have a difference. We don’t know that there’s a difference here, right? So I’m going to include a few things we’re going to add into this section, but the reality is you’re probably going to do all of them for both of these patients coming through the door. So imaging, you’re going to start with a non-contrast CT, right? If you have someone who you suspect has a stroke, because we’re going to be excluding that hemorrhagic stroke, we’re going to be looking for that bleeding. If we’re looking for ischemia, then it’s going to be an MRI.

You could also do a carotid ultrasound to check for stenosis or plaques in the carotids, which may be throwing off emboli. You can do an echocardiogram for the same reasons. You’re going to look at the heart to see if there’s a source of embolus there. If you think that there may be AFib, you can do an ECG or a Holter monitor. And then, of course, we’re going to do blood work, a PT, PTT, INR, lipid panel, etc.

Now, here’s where the difference comes in. Acute management for a ischemic stroke is going to be TPA, right? So we’re going to administer that within four and a half hours of the onset of symptoms, as long as there are no contraindications. Ideally the emergency room standards are door to TPA should be under 60 minutes, but it’s 4.5 hours from the onset of symptoms. This is the acute treatment for ischemic stroke. Sorry, this is acute treatment for an ischemic stroke. You’re going to want to do TPA as long as there’s no contraindications.

What are the contraindications? Well, there’s two categories. There’s an absolute contraindication and there’s a relative contraindication. So absolute contraindications are active bleeding or a bleeding disorder, intracranial hemorrhage or confirmed or suspected on imaging. So if they have an intracranial bleed, you don’t want to give them TPA. TPA will stop and break up clots, right? If they have an active brain bleed, we don’t want to do that.

If they’ve had recent major surgery or trauma within 14 days, if they have severe uncontrolled hypertension, so greater than 185 over 110. If they’ve got an intracranial neoplasm or a known AVM or aneurysm, we’re not going to want to do this because we want to make sure that they can clot off if they need to. If they’ve had a recent stroke or head trauma within the last three months, a platelet count less than 100,000 or some other abnormal coagulation. An INR greater than 1.7 or a PT greater than 15 seconds. Those are absolute contraindications. And part of that is, I tell students a lot, you don’t have to necessarily memorize lists like this. You probably should because it’s easy to write a question on.

But one of the things about lists like this is all you really have to do is consider who would you not want to give a clot-busting drug to, right? What would be a reason you wouldn’t want to? Well, an active bleed is a great reason. Recent major surgery or trauma, good reason. Severe uncontrolled hypertension, good reason not to do this, right? If they have a known AVM or aneurysm, good idea not to do this. So those are your contraindications.

Now, you can memorize that list, and perhaps you should. But… but you can also think through what’s what you would want to do in a clinical setting, and who you would want to avoid giving this to. So, then we move on to relative contraindications. So, pregnancy or recent delivery within seven days, probably not a great idea. Minor or rapidly improving stroke syndrome symptoms. So, if they’re not that bad of symptoms, or if they’re getting better quickly, maybe we want to hold off on this.

If they have seizures at stroke onset, recent GI or genitourinary bleeding, or a recent lumbar puncture or arterial puncture in a non-compressible site. So these are times that you can think about giving it, but you want to consider it. Another option here is a thrombectomy, right? So you can actually go in and get the thrombus out if the vessels are big enough. The other key here is post-stroke management, you’re going to want to use antiplatelet therapy, aspirin to prevent reoccurrences, statins for long-term vascular health, and blood pressure and glucose control. So again, we’re going to look at how we’re managing these two different patients, how they come in through the door, how we’re going to identify which one is which, and what we’re going to do to treat them. Right?

In one, it was lower intracranial pressure, blood pressure control, perhaps a craniotomy, perhaps going in and clipping an aneurysm. In the others, it’s TPA. And then aspirin. And then also we’re going to do blood pressure control and all the rest of it, right? So it’s going to overlap some.

Okay, and the last part for this section is transient ischemic attacks, or TIAs. This is a temporary disruption of blood flow to the brain causing a stroke-like symptoms without permanent tissue damage. This is easy to understand if you understand the others. Typically, symptoms resolve in about 24 hours, but they may resolve in just a few minutes or just a few hours. The interesting thing here is that 10 to 15 percent is the risk of stroke within three months of a TIA. So you’re basically, it’s like a mini setup for a stroke. You’re looking at somebody who is a good candidate to have a stroke in the next three months if they present with a TIA.

Okay. Clinical presentation here, sudden onset of neurological deficits that vary depending on the area of the brain affected. So very similar to what we just got done talking about. You can have motor deficits. So contralateral hemiparesis or weakness, sensory deficits, contralateral numbness or tingling, temporary vision loss, diplopia, aphasia or dysarthria. I think I got that right this time. Dizziness, poor balance or ataxia.

And then you get confusion, disorientation. But typically the symptoms resolve within 24 hours without any intervention. That’s really the key here. Risk factors here are age greater than 55, males get this more often than females, hypertension, diabetes mellitus, smoking, hypercholesterolemia, AFib, carotid artery stenosis, or a family history of stroke or TIA. That’s really going to be the same list as the other strokes, which I did include in the podcast, but that list is pretty solid. It’s something you want to pay attention to. Labs, studies, and physical exam findings.

For physical exam, your neurologic exam, obviously assess motor, sensory, speech, and cognitive function. The one added thing here might be carotid bruit to suggest carotid stenosis. I guess I could have included that in ischemic strokes as well, right? So we’re looking for that carotid stenosis. Imaging, non-contrast CT or MRI to rule out ischemic or hemorrhagic stroke, carotid ultrasound like we talked about, and a CT or MR angiography to evaluate cerebral vasculature. So again, we’re doing the same workup, right? Because we don’t know what it is.

If this person comes through the door and it’s only been an hour since symptoms started, we don’t know if it’s a TIA or not. We can do an echo to detect cardiac sources of emboli, so like if they have AFib. And again an ECG or Holter monitor for the same reasons. Blood work, we could do a lipid panel, PT, PTT, INR, CBC. Again, similar, similar workup because we don’t have an answer. We don’t know yet.

Okay, and then we move into acute management. So here we get to antiplatelet therapy for non-cardiogenic small vessel clots, which are platelet rich. So that’s going to be aspirin, clopidogrel, which is Plavix, or ticlopidine. I am out of practice. I’m worse than usual. Well, these names. Anticoagulant therapy for cardiogenic fibrin-rich clots, which would be heparin.

So followed by long-term warfarin or direct anticoagulants. Blood pressure control, reduced risk of reoccurrence and statins to lower cholesterol and reduced risk of vascular. I’m sorry, reduce the vascular risks. So I’m going through this and I haven’t done, well, actually let’s just finish up and then we’ll spin back around. So surgical management, you could do a carotid endarterectomy if the carotid stenosis is greater than 70%, if you think that that may be the cause of the embolus that are causing the TIAs or causing the TIA. Lifestyle modification, so smoking cessation, weight loss, and regular exercise, healthy diet, all these things to improve cardiovascular health, right? Those are the things we’re trying to achieve.

So as I’m going through the notes and as I’m thinking about this, right, I’m trying to figure out, so as the patient comes through the door, all of the information says, if you believe that you have TIAs that are caused by non-cardiogenic small vessel clots, they’re platelet-rich and give them aspirin, Plavix, or ticlopidine. If you think they are cardiogenic, then they’re fibrin-rich. You want to give them heparin or warfarin, Coumadin.

Okay. So I understand that. My problem comes in when it’s like, okay, so what about TPA? How do I know the difference? So if I have a patient comes through the door and I’m not sure, I think they have stroke symptoms, but I don’t know what’s going on. Do I give them, you know, after, let’s say I get an EKG and then I’m saying, okay, they have AFib.

Now, what do I give them, right? Well, if you’re under four and a half hours, it seems to me that you’re giving TPA because you’re assuming this has been a ischemic stroke. If the symptoms are resolving, that was part of our relative contraindications. I’m going to get this right, don’t worry, a little practice, I’ll get better. It’s been a year, relative contra indications, right? So if symptoms are improving, or if a patient comes into the ER, and they’re like, oh, I had these symptoms, or my wife or my husband had these symptoms, but they seem to be improving, and they seem to actually have gotten better, but I’m terrified because it looked like he had a stroke, right? Then we wouldn’t be giving TPA, we’d be looking more towards these other options like the antiplatelet versus the anticoagulant therapy.

And I think deciding between them may also be something that’s important to you down the road. So anyway, that’s how I try to think about these things. I try to think like, how is the patient going to come in? How is my decision chain going to go? And how are they going to ask it on a test for me to decipher between the two or to figure all that out? So in this case, that’s how I’m thinking about this. That’s how I’m moving forward.

So I want to know if I think it’s a TIA, if I think it’s in a ischemic stroke, if I think it’s a hemorrhagic stroke, how is that going to present? What it’s going to look like? What are the labs and studies going to be different about it? And then how do I treat it differently? What am I going to do moving forward? The other thing to consider in this section are stroke mimics. So there are things that can look like they are strokes, but they aren’t strokes, right?

So hypoglycemia can have symptoms like a stroke. Seizures can have symptoms like strokes. Migraines, conversion disorder, intracranial tumors or abscesses can look like strokes. Infections like encephalitis or meningitis can look like a stroke. Another good one is multiple sclerosis. During an acute demyelinating event, they can look like strokes. We’re trying to rule all of these other things out.

So, now that I’m thinking about this, I probably should have added a glucose levels to every one of these labs that I didn’t have in there. But I’m going to go back and put that into the notes. Something to consider. So here’s another really good example where you’re like, oh, I don’t want to learn this if I don’t know everything yet. Well, I had something that wasn’t in my notes, but as I’m going through it and I’m thinking more about it, well, I need to go back and add this. Is that a problem? No, because now actually it stands out to me as something that’s important that I missed the first time around.

So you can look at that as though it’s either a problem or a good thing. So now I know if I’m going to be looking for a stroke or a TIA and I see a patient come through the door, not only am I going to want to check their blood pressure, but I’m going to want to check their glucose levels as well because this can all be caused by simple hypoglycemia. And I don’t want to be giving them TPA if all I have to give them is a cookie, right? So things to keep an eye out.

All right. And that will bring us to the end of, I’m going to call this our first episode of 2024 on hemorrhagic strokes. Ischemic strokes and TIAs and how to compare them and how to think about them. We’re going to wrap up with our study tip and then give the answers to our priming questions before we talk about a little bit more about what’s going to go on in next week’s episode.

All right, so our study tip for today. I always cover a study tip in every episode because I think it is incredibly valuable to assess your skills. Content, content, content is what everybody he thinks about and it’s so important. But in addition to that, is polishing your skills, getting better at the game. Super important. So I include one in every single podcast. Some people just gloss over them and other people email me and say, wow, that’s the best part of every show.

And to me, honestly, that is the best part of every show. That’s actually one of the main reasons I do the shows is to get you to listen through to get to the study tip. Because to me, it’s so important to be able to adjust our skills and improve as we go on in pretty much everything we do. But if we’re looking at this, this game we’re playing this, this, that we have to do certain things to get certain scores, improve our grades, and there’s all these rules. And how can we improve how we perform in that setting? I think it’s so valuable. So anyway, what I want to talk about really briefly today, our study tip for today is find out what works for you.

Too often, I’m hearing from students who are like, well, Becky uses this technique. So I started using it. She gets better grades than me, but I hate it. And my advice to that person is stop using it if you hate it, if it doesn’t work for you. All of our brains are slightly different from each other. Some of our brains are drastically different from other people’s. We need to find techniques and ways of doing things that work for us.

Within the 33 Days program, I provide a whole plethora of different tools and techniques. And some people use, have already been using some of them. Some people hate some of them. Some people find new ones and are amazed by it. But what I don’t want people doing is taking everything and thinking they have to do it. Same thing, different professors will teach test-taking styles and test-taking tips. I love that.

I think it’s amazing. But it doesn’t mean you have to use every tip or every tool you’re given. Some things work better for some people. Some things work better for other people. My recommendation is that you try different techniques and you understand there are different techniques and different methods out there for studying, for testing, for anxiety management, for getting to sleep at night, for getting enough sleep, all of these things, for time management. There’s so many different tools. The problem is what works for the person sitting next to you in class may not work for you.

In fact, there’s a good chance it won’t. So you need to be testing and looking for different options when it comes to all of these areas.

All right, that’s our study tip for today. Do what works for you.

Let’s move on and answer our priming questions. Which medication is commonly used to reduce intracranial pressure and hemorrhagic stroke? Did you hear this one? I said this pretty plainly in the notes. It’s going to be mannitol or hypertonic saline. I think I said hypertonic solids, right? So that should have stood out to you.

What is the typical time window for administering TPA in acute ischemic strokes? You’re going to have to know this. Got to know it. Within four and a half hours of symptom onset. In a patient with a TIA from a cardioembolic source, what category of medication is typically indicated? So cardioembolic is going to be anticoagulants like warfarin, Coumadin. What systolic blood pressure target is recommended for acute management of hemorrhagic strokes?

We hit this one too specifically, less than 140.

All right. So that was an absolute ton of fun. I am so happy to be back behind the microphone. Yes, I’m going to fumble a little bit. Yes, I’m going to stutter a little bit. Yes, my pronunciations of medications will be terrible. That’s going to continue with or without practice.

And I apologize for that up front. But we’re going to work through some of the kinks. But I just wanted to get an episode out there. I didn’t want to delay it and spend a lot of time making minor improvements. I really want to just get this out there to you guys. I thought, one, you deserve it. And two, which is a lot of fun for me.

And I’ve really just enjoyed spending more and more time with students and working directly with them. So I thought it was only fair to repay that with getting back to recording the podcasts. So as for next week, I have some really, really cool stuff going on. My goal is to be releasing, wrong button. My goal is to be releasing companion episodes to each of these. We’re going to walk through questions. We’re going to walk through styles.

We’re going to walk through how to remember some of the things and put a little more depth into what we’re doing in that every other week style. So I hope you come back and join me for that. Let your classmates know, let your cohorts know, let your faculty know that I’m back to producing these. And I can’t wait to hear from you about how you’re doing in school and how it’s helping you. Take care, good luck. I’ll see you next week.