›Dual antiplatelet therapy for minor stroke or high-risk TIA
›Aspirin 100 to 300 mg plus clopidogrel 75 mg daily
›21 days then monotherapy based on POINT and CHANCE trials
›ICD-10 Z79.82 long-term aspirin use
›IV methylprednisolone
›1000 mg IV daily for 3 to 5 days
›Standard regimen for acute MS relapse including INO
›Accelerates recovery speed but may not change long-term outcome
›Class I recommendation per multiple sclerosis guidelines
›Administration considerations
›Monitor blood glucose for steroid hyperglycemia
›Blood pressure monitoring
›Mood and sleep disturbance counseling
›Oral prednisone alone
›Avoid as monotherapy for acute MS relapse
›Associated with increased relapse risk in Optic Neuritis Treatment Trial
›Do not substitute for IV methylprednisolone course
›Plasma exchange for refractory relapse
›5 to 7 exchanges over 14 days
›Consider if inadequate response to IV steroids
›Class IIa recommendation for severe relapses
›IVIG alternative
›0.4 g/kg/day IV for 5 days
›Option when plasma exchange not available or contraindicated
›Disease-modifying therapy initiation or optimization
›High-efficacy agents for relapsing MS
›Ocrelizumab, natalizumab, or alemtuzumab
›Consider in highly active or breakthrough disease
›Moderate-efficacy agents
›Fingolimod, dimethyl fumarate, cladribine
›Fingolimod requires baseline ECG and cardiac monitoring
›First-dose 6-hour observation for bradycardia and heart block
Anti-GQ1b syndrome treatment
›IVIG for Miller Fisher syndrome or Bickerstaff brainstem encephalitis
›0.4 g/kg/day IV for 5 days
›Generally self-limited with good prognosis
›IVIG shortens duration based on observational data
›Plasma exchange alternative
›5 exchanges over 14 days
›Equivalent evidence to IVIG
›Monitoring
›Respiratory function for GBS overlap
›FVC monitoring if bulbar or respiratory symptoms
›ICU escalation if FVC < 20 ml/kg or bulbar compromise
Secondary stroke prevention
›Risk factor modification
›Antihypertensive therapy
›Target SBP < 130 mmHg for secondary prevention
›ACE inhibitor or ARB first line
›High-intensity statin therapy
›Atorvastatin 40 to 80 mg daily
›LDL target < 1.8 mmol/l for atherosclerotic stroke
›Anticoagulation for cardioembolic stroke
›Atrial fibrillation: DOAC preferred over warfarin
›Apixaban 5 mg PO twice daily or rivaroxaban 20 mg PO daily
›Start 2 to 14 days after ischemic stroke depending on infarct size
›Glycemic optimization
›Diabetes management in stroke setting
›Target glucose 7.8 to 10 mmol/l in acute stroke
›Avoid hypoglycemia which worsens ischemic injury
›HbA1c optimization long-term
›Diplopia relief
›Temporary monocular occlusion
›Eye patch over non-dominant eye
›Alternating occlusion to prevent amblyopia in prolonged cases
›Prism glasses
›Fresnel prism for temporary correction
›Formal prism fitting by optometry or neuro-ophthalmology
›Strabismus surgery consideration
›Only after stable deficit > 6 months
›Neuro-ophthalmology referral
›Wernicke encephalopathy treatment
›Thiamine IV before glucose
›Thiamine 500 mg IV three times daily for 2 to 3 days
›Then 250 mg IV or IM daily for 5 days
›Glucose before thiamine worsens Wernicke encephalopathy
›Nutritional support
›Oral thiamine 100 mg three times daily maintenance
›Address underlying malnutrition or alcohol dependence