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Primary care follow-up for stroke patients carries many nuances and guideline recommendation updates. In this thread we outline one possible approach with 5️⃣ issues to be addressed.

#neurotwitter #stroke @OntarioCollege @ABFamDocs @CMA_Docs. cc: @draravindganesh Case:
A 76F is admitted to stroke ward after suffering a L MCA stroke- undergoing thrombolysis & endovascular therapy. She makes an excellent functional recovery from her stroke and is discharged home with primary care follow up in 1-2 weeks, and specialist follow up in 3-months

🚨Acute #stroke case (from the archive):

Patient in 60s presents with sudden onset fluctuating LOC, dysarthria, mild right arm weakness (disabling)

Last seen normal 2hrs (witnessed onset).

You urgently take to CT- motion artifact, no clear early ischemic changes. CTA normal. 2 schools of thought/approaches:

Approach #1⃣: Acute onset, disabling symptoms- proceed with lytic 💉and defer CTP

Approach #2⃣: Dx is still a bit unclear (ddx: seizure⚡️, etc)- proceed to CTP

If in camp #2, here are the CTP maps (CBF, MTT, Tmax>8s)

The tPA recommendation on the NNT website changed to "the net benefit & harms are unclear due to uncertainty of data" authored by @TheSGEM

I believe it's helpful to clarify a few points on this debate so we present families with correct info before they make a decision on tPA.

https://twitter.com/TheSGEM/status/1388546277797994499

1. The main source for the recommendation is from a review paper in Emerg Med Australasia (see below).

This paper includes all thrombolytics (anistreplase, streptodornase, streptokinase, urokinase, lumbrokinase, duteplase, lanoteplase, pamiteplase, etc)

pubmed.ncbi.nlm.nih.gov/27561375/