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Uncertainties and controversies in neurology and medicine - with focus on stroke and TIAs.

Part 1 of 4. This 4-part series focuses on controversies in the area of strokes and TIAs. Future Rife with Strife series will focus on controversies in other areas of neurology.

Hear these reports:

The Role Of Controversies In The Advancement Of Medicine: medical controversies, with criticism and debates, are the way that optimal medical therapies crystallize.

TIA and Stroke Admissions: a study on primary care physicians last year in the journal Stroke showed that even when strokes and TIAs were well recognized as medical emergencies by the PCPs, essentially 30% of them would not admit the TIA patients as a medical emergency.

Immediate Treatment of TIAs: the PROFESS trial is underway comparing clopidogrel (Plavix) with ASA/dipyridamole (Aggrenox) for secondary stroke prevention. Until those results are available, which drug is best to use for the prevention of stroke in TIA patients? Or is Aspirin alone adequate ?

Carotid Stenting Versus Carotid Endarterectomy: Which do you recommend for your patients and why?

Intra-Arterial Thrombolytics for the Treatment of Acute Stroke: You may recall the “Lazarus phenomenon” from STAT episode #61. Dramatic improvement after intra-arterial thrombolytic occurred in twenty-five percent of the patients. Might this ‘emerging therapy’ someday take the place of IV infusions of thrombolytics?

Percutaneous Closure of Patent Foramen Ovales for Stroke Prevention: The relative risk of any thromboembolic event is 4-fold in patients with a PFO. A study in the New England Journal of Medicine 4 months ago support that PFOs and resulting paradoxical emboli are a cause of stroke in both older patients and younger patients. How about this proposition: the large-scale procedural intervention - percutaneous PFO closure - for the prevention of strokes (and migraines)? Now there’s a controversy that society is probably not quite ready to grapple with.

Next week’s show: Controversies about neuroprotection before or after acute ischemic stroke, and EDTA chelation therapy as a preventive and treatment for cerebrovascular and cardiovascular disease.

Flow Productions will be producing additional lines of podcasts based on cutting medical news and information. Click for demos: Audio magazine format and video (’enhanced podcast’). If you are interested in sponsoring one of the shows please contact info@flowproductions.org.