Ischemic stroke or TIA

L. sided weakness and numbness. R/o acute ischemic Stroke
-H&P performed.
–Ddx of stroke, reviewed.
-Likely ischemic stroke (which is 87 % of us U.S strokes vs. 13 % hemorrhagic stroke).
-admit to telemetry. Cardiac monitor for arrhythmias.
-No dextrose in IVFs for stroke pts. b/c it worsens outcomes.
-f/u transthoracic echo (TTE) to assess for thrombus or vegetation, w/ bubble study to assess for PFO / atrial septal aneurysm
-Reviewed CT head performed in the ED
-f/u on MRI of the brain (without contrast)
-CTA head with contrast and CTA neck with contrast.
-f/u CTA / MRA neck and brain. [CTA gives a better image and is preferred if kidney function is good since pt requires contrast. Use MRA if poor kidney function]
-If unable to do CTA/ MRA, we will get B/L carotid U/S and Doppler.
-f/u on UDS
-f/u on HbA1c, Fasting Lipid Panel (FLP), TSH to assess for comorbid conditions.
-neuro-check Q4H
-Keep blood sugars WNL.
-PT/OT consult
-Bedside swallow evaluation for now. Speech therapy to do a formal evaluation if the patient fails bedside swallow.
-Antiplatelet tx: ASA 81mg
-Statin: High-dose statin – Atorvastatin 80mg. LDL goal <70
-Permissive hypertension if < 220/120 since no lysis will be done. Keep <185/110 if lysis to be done. If ceiling reached, treat with IV antihypertensive, permissive hypertension for 24-48 hours, after which restart antihypertensives with a goal blood pressure less than 140/90.
-Neurology consulted (Dr. ______)

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*** For stroke, you only need either Aspirin or Plavix, not both. The only indication for dual antiplatelet therapy is when the patient has a stent such as a cardiac or carotid stent. Patients with stroke and CAD may also be on dual therapy as indicated for the CAD, but not for the stroke.