The Stroke Journey

For acute care physicians, anticoagulated patients presenting with intracranial hemorrhage (ICH) is an incredibly challenging clinical scenario. ANNEXa-I is a randomized, controlled, clinical trial which provides clinicians with important information on appropriate reversal of anticoagualtion to optimally care for these patients.

Real World studies can provide the foundational support necessary for clinicians to effectively manage anticoagulated patients with severe, often life-threatening intracranial and gastrointestinal bleeding. While randomized controlled clinical trials have provided the initial data necessary for appropriate use of reversal agents such as andexanet alfa for Factor Xa associated bleeding, broader studies enrolling thousands of patients, many with significant co-morbidities, are extremely valuable to clinicians. New information regarding the randomized controlled trial ANEXXA-I, which was halted due to andexanet alfa efficacy, provides additional information supporting reversal therapy for severe bleeding.

Experts in Emergency Medicine, Pharmacy, and Neurocritical Care describe the impact of real world evidence on the care of life-threatening bleeding in the anticoagulated patient. While clinical trial data remain the standard for clinicians, real world data provide important additional information on the use of a particular Repletion or Reversal therapy for these patients.

ICH remains deadly and pathways matter but they aren't always what we need and barriers can be overcome with knowledge.

Coordinating the necessary care for hemorrhagic patients is complicated- learn the ropes from experts on the UC Stroke Team. "Smoother, faster better" is the name of the game.

How and where to treat ICH patients- politics, reversal agents, and science all in one podcast!

AI is coming but are we ready for it in stroke imaging?

Is telemedicine the savior for stroke care or the start part of the downfall of acute medicine?

Stroke center designations are the currency of the realm; but does it matter to patients?

Telemedicine is the future of stroke - is it the future of stroke research?

MRI imagining is becoming more available in acute settings; understanding MRI in stroke is critical to staying ahead of the curve.

The ASPECTS score has become more widespread in use with the increase in availability of endovascular therapy. This podcast is a must if you care for acute stroke patients. This is an absolute "must-know" topic for anyone who looks at head CT images in strokes.

Ataxia and dystaxia are often missed clinically. But they're important and potentially disabling. Listen to this podcast to learn more and help you identify these high-risk patients.

Posterior circulation strokes are often devastating. The diagnostics are different and the treatments are evolving. If you care for stroke patients, this podcast is a must.

Confusion isn't really a stroke symptom but aphasia clearly is. One is life threatening and the other can often be self limited and benign. Are you sure your neurological exam is up to the task?

CTP is alluring in acute stroke and continues to become more available. But it's complicated. Learn the pitfalls and traps from a true expert in perfusion imaging.

When patients need anticoagulation but have had an ICH or large ischemic stroke, when do we restart anticoagulation? When, if ever, is it safe?

Intracerebral hemorrhages are challenging to manage and patients need immediate interventions to preserve life and limit morbidity. Lessons learned from the ICU and ED shed light on how to best care for these patients.

Anticoagulation in clinical practice is more common and more complicated every day. Understanding what they are, how they're used and when you'll see them in the clinical arena is critical. Two experts discuss their understanding of the landscape of anticoagulation and what you need to know about it.

Ever wonder why the FDA didn't approve the extended time window for tPA after ECASS3? Listen here to understand the discussion.

The NIHSS remains the fundamental assessment of stroke severity. However, some have called for modifying the NIHSS to better capture disability. Is it time to change the NIHSS?

The NIHSS was a research tool meant to limit variability and provide uniform quantifiable assessments  of stroke severity.  As the de facto standard for stroke exams and scores, it has withstood the test of time.  However, there is more to the assessment of acute stroke severity and this podcast takes a deep dive into what else we need to be doing besides the NIHSS.

Mismatch is your friend if you want to treat acute stroke patients beyond 3 hrs. While the clock was once the king, tissue imaging may now define what brain is salvageable and what has been lost. Listen here and see if you agree that the clock is dead in stroke.

The standard of care can feel elusive. Listen here as Dr. Knight shares his expertise regarding the definition of the SOC in extended window therapy for tPA. It's not a simple question and Dr. Knight is the one to answer it.

Identification of patients at high risk for secondary ischemic event, after initial event or post TIA...is minimal tissue damage really that big of a deal related to secondary stroke? Drs. Galen Henderson of Brigham and Women's Hospital and Jordan Bonomo of the University of Cincinnati discuss key perspectives from a neurocritical, emergency medicine, and stroke perspective related to this important area of medicine.

The association of genetic polymorphisms and P2Y12 inhibitors in regards to efficacy for patients with ischemic stroke or transient ischemic attack (TIA) remains controversial. Drs. Deepak Bhatt of Brigham and Women's Hospital and Natalie Kreitzer of the University of Cincinnati discuss key perspectives from a neurocritical, emergency medicine, and stroke perspective related to this important area of medicine.

Ever wonder how a world renowned stroke neurologist teaches the stroke exam? Listen in to learn the foundations of the neurologic exam and strategies for efficiently identifying deficits in stroke patients.

CT Angiography of the head and neck has become a standard in the Emergency Department as part of the initial workup of a patient with a suspected stroke, but they are challenging to interpret.

The posterior circulation is the source of controversy and challenges in the management of acute stroke patients. Listen to a neurointensivist and interventional stroke physician talk to an emergency physician about the posterior circulation patients. Acute dizziness and vertigo can be separated clinically and Dr. Smith teaches us how in this podcast.

Learn what really happens in the mind of a stroke expert during the evaluation of an acute stroke patient. How to avoid pitfalls and how to make sure the patients you are caring for understand what is happening. Dr. Knight guides listeners through the steps to effectively diagnose and treat acute stroke patients.

Non-contrast head CT remains the initial imaging modality in the workup of a patient with a suspected stroke, yet not everyone is comfortable with real time interpretation.

Endovascular treatment of acute stroke is intimidating to many providers. Dr. Grossman takes this opportunity to share his expertise and help the rest of us understand what neurointervention can do for acute stroke patients and what the future of endovascular stroke care holds.

Identifying difficult stroke syndromes with Dr. Stacie Demel- learn from one of our nation's experts in stroke education and care as she takes us through the stroke syndromes that keep her up at night. The posterior circulation, the young patient, and the potential mimics that confuse us all are the focus of this podcast.

The destination for prehospital patients with suspected stroke has been controversial for many years. Should they be taken to the closest ED, the closest stroke ready hospital, or the closest comprehensive stroke center? Does rural, suburban, or urban location matter when selecting a receiving institution? The new AHA white paper addresses this and more.

Endovascular stroke care is the criterion standard for LVO treatment, yet not everyone is fluent with data and techniques.

Nurses in the emergency setting are the key to stroke patient progression. From first point of assessment and triage, ED nurses set the standard.

Statistics can illuminate or obfuscate. Clinicians need to understand acute stroke trial data and statistics in meaningful ways, but challenges abound.

The NINDS trial was the seminal study of IV-tPA in the treatment of acute stroke. Yet controversy still exists around the trial methodology and the interpretation of the data. Was anything missing from NINDS? Does it still resonate nearly 25 years later?

Imagine a mobile stroke unit, with a CT scanner, arriving to care for stroke patients at the first point of medical contact. What are the possibilities and what are the data?

The NIH Stroke Scale is beneficial when used correctly but is has its limitations. Relying entirely on the NIHSS will miss significant disability in a number of patients. Acute stroke care demands more than just an NIHSS assessment.

Acute interventional management during the COVID pandemic requires a change of focus and practice. Challenges abound and danger exists at every decision point.

Once a stroke is suspected in the field, it stands to reason that the destination matters for the patient. But how much does it matter and where should patients be taken? Data meets politics in this compelling podcast.

Heparin in stroke remains controversial. Understanding the history and data and essential to mastering stroke care.

Stroke treatment data are hard to interpret and can be misleading. A lot of misinformation has made its way into the literature and has confounded acute stroke care. Understanding NNT and NNH can help clinicians understand risks and benefits in a meaningful way.

In today's technology-savvy world, we have come to expect getting goods and services delivered on demand and on our terms. We want things right away. The concept of having to wait for something is somewhat frowned down upon.