Three Pearls that came out of our great discussion with Katherine today discussion:
1. Neuroanatomy pearl: Normally functioning frontal lobes help move your eyes to the contralateral side. Hence, in acute stroke (decreased cortical activity) the gaze will tend to deviate in the direction of the lesion (side contralateral to the lesion is overpowering the damaged side) where as in seizure (increased cortical activity) the gaze will tend to deviate away from the lesion (the hyperactive side overcomes the normal side).
2. Unlike in ACS, we don’t need to be in a hurry to give an altered patient an aspirin/statin when stroke is a possibility. We learned that the number needed to treat is very high and that studies of aspirin after stroke gave aspirin within 48 hours, not necessarily immediately. Take home: especially if the patient is altered and has dysphagia you can let the situation settle out before starting the aspirin/statin.
3. Me before report today: “I can’t get an MRI because my patient is agitated and can’t sit still for an hour.”
Me after being taught by Katherine: “Not so!!!”
There is a “rapid” MRI protocol to rule out stroke that you can ask rads about which prioritizes FLAIR and is only about 5 minutes long. It can be a real game-changer!
Thanks guys for another great report we will see you in the morning!!