Changes

*Dx: Ischemic vs. Hemorrhagic. Can localize stroke based on symptoms. NCCT head to rule out hemorrhage; CTA, MRI to look for filling defects and ischemic injury; TTE, telemetry to evaluate for afib. Differential includes TIA, seizure. Stroke in a young IV drug user with a murmur, think '''mycotic aneurysm'''.

*Dx: Ischemic vs. Hemorrhagic. Can localize stroke based on symptoms. NCCT head to rule out hemorrhage; CTA, MRI to look for filling defects and ischemic injury; TTE, telemetry to evaluate for afib. Differential includes TIA, seizure. Stroke in a young IV drug user with a murmur, think '''mycotic aneurysm'''.

*Tx: For ischemic stroke, give tPA within 4.5 hrs of symptom onset, otherwise hep gtt. If large occluding clot in major vessel, can do endovascular thrombectomy within 24 hrs. Contraindications to tPA include recent major surgery, history of hemorrhagic stroke, BP >180/105 mmHg, Plt < 100k, INR > 1.7, age < 18, intrabdominal bleed. Use caution in the 3-4.5 hr window in patients over 80, with DM, with a recent stroke, or on DOACs. '''Keep BP below 180/105 mmHg to avoid hemorrhagic transformation''' and avoid starting anticoagulation or anti platelet agents in the first 24 hrs after tPA. Prevention includes aspirin ('''even if patient has history of recurrent falls'''), statin, clopidogrel, blood pressure control, rate/rhythm control or ablation/Watchman for Afib, weight loss, diabetes control, and smoking cessation. Treatment for hemorrhagic stroke includes blood pressure control, surgical decompression (ventricular shunt or craniotomy).

*Tx: For ischemic stroke, give tPA within 4.5 hrs of symptom onset if no contraindications. If large vessel occlusion, can do endovascular thrombectomy within 24 hrs. Contraindications to tPA include recent major surgery, history of hemorrhagic stroke, BP >180/105 mmHg, Plt < 100k, INR > 1.7, age < 18, intrabdominal bleed. Use caution in the 3-4.5 hr window in patients over 80, with DM, with a recent stroke, or on DOACs. '''Keep BP below 180/105 mmHg to avoid hemorrhagic transformation''' and avoid starting anticoagulation or anti platelet agents in the first 24 hrs after tPA. Prevention includes aspirin ('''even if patient has history of recurrent falls'''), statin, clopidogrel, blood pressure control ('''most important'''), rate/rhythm control or ablation/Watchman for Afib, weight loss, diabetes control, '''start ppx dose heparin between 24-48 hrs (if not already on thrombolytics, therapeutic anticoagulation, or DAPT)''', and smoking cessation. Treatment for hemorrhagic stroke includes blood pressure control, surgical decompression (ventricular shunt or craniotomy).

==Hematoma==

==Hematoma==

=Neuromuscular Junction=

=Neuromuscular Junction=

==Myasthenia Gravis==

==Myasthenia Gravis==

*H&P: Autoantibodies against AChR, presents with muscle weakness that worsens as the day progresses and with exercise and improves after sleep. Constantly used muscles (think postural muscles, diaphragm, and eyelids) are affected first. May have positive family history. May have thymoma.

*H&P: Autoantibodies against nAChR, presents with muscle weakness that worsens as the day progresses and with exercise and improves after sleep. Constantly used muscles (think postural muscles, diaphragm, and eyelids) are affected first. May have positive family history. May have thymoma.

*Dx: Look for ptosis that improves with ice pack test. Edrophonium test is positive. '''Single-fiber''' EMG shows unstable "jittery" baseline between APs. '''CT chest to look for thymoma.'''

*Dx: Look for ptosis that improves with ice pack test. Edrophonium test is positive. '''Single-fiber''' EMG shows unstable "jittery" baseline between APs. '''CT chest to look for thymoma.'''

*Tx: 1st line pyridostigmine. '''2nd line steroids or immunomodulating meds (e.g. cyclosporine, azathioprine). Plasmapheresis or IVIG for myasthenia crisis. Thymectomy may reduce symptoms and exacerbations.'''

*Tx: 1st line pyridostigmine. '''2nd line steroids or immunomodulating meds (e.g. cyclosporine, azathioprine). Plasmapheresis or IVIG for myasthenia crisis. Thymectomy may reduce symptoms and exacerbations.'''