Update your management of stroke and TIA in primary care. Stroke neurologist, Chris Favilla MD (University of Pennsylvania), walks us through the plumbing of the brain, so we can identify ischemic risks in stroke and TIA patients to prevent recurrences.  Learn factors that make a TIA high risk, which imaging studies to order, new research around aspirin dosing, dual antiplatelets, DOACs, cardiac monitoring and more! ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Producers: Molly Heublein MD; Matthew Watto MD, FACP Writer (including CME questions): Molly Heublein MD Cover Art: Bryan Brown MD Hosts: Stuart Bringham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto, MD; Matthew Watto MD, FACP Guest: Chris Favilla, MD Time Stamps 00:00 Intro, disclaimer, guest bio, and a bad pun 04:20 Chris’ one-liner, advice as a teacher, book recommendation -The Goldfinch,  07:40 Molly’s pick of the week -Extreme Measures (book) by Jessica Zitter 08:40 A case of TIA; definition of TIA 12:14 Stroke territories 14:24 New definition of TIA 16:00 Differentiation from complex migraine 19:17 Risk stratifying TIA and ABCD2 score 22:00 A bit on tPA 24:01 Workup for TIA; workup for amaurosis fugax 25:36 CNS imaging studies after stroke or TIA; Choice of imaging study 33:15 HINTS exam for posterior circulation stroke 34:48 Is an echo necessary? Bubble study for PFO? 38:32 Duration of afib monitoring 40:24 Echo reports: what to look for in patient with stroke or TIA; “soft markers” 41:55 Blood testing after Stroke and TIA (lipid panel, HbA1C; +/- RPR, coags, CBC) 43:50 Folic acid; Sparkle trial: high dose atorvastatin versus placebo for secondary prevention 47:00 Incidental finding: multiple patchy infiltrates in a patient without stroke or TIA; Is it significant? 48:50 Aspirin therapy after TIA; Dosage adjustment based on weight? 51:10 A case of stroke; TOAST trial and classification of acute stroke; ESUS; aortic arch atheromas 55:58 Large artery strokes (hypoperfusion, acute thrombosis, artery to artery embolization) 57:15 Antiplatelets after stroke and TIA; DAPT and duration of therapy 62:57 Antidiabetic drugs and stroke 63:40 Lightning round: CHA2DS2VASc score and women; how much afib is significant?; 66:32 Are all DOACs created equal?; 68:20 Regaining function after a stroke; 69:47 Silent infarcts on imaging 71:54 Resources for stroke: Decision making in neurology textbook 73:28 Outro