from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
import copy

# ── Colour palette ────────────────────────────────────────────────────────────
DARK_NAVY   = RGBColor(0x0D, 0x1B, 0x3E)   # slide background / title bar
MID_BLUE    = RGBColor(0x1A, 0x53, 0x8A)   # accent bars
ACCENT_TEAL = RGBColor(0x00, 0x8C, 0x9A)   # bullet icons / highlight
LIGHT_GREY  = RGBColor(0xF4, 0xF6, 0xF8)   # content area bg
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
TEXT_DARK   = RGBColor(0x1E, 0x1E, 0x2E)
YELLOW_HL   = RGBColor(0xFF, 0xD7, 0x00)   # key stat highlight

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]   # fully blank


# ── Helper utilities ──────────────────────────────────────────────────────────
def add_rect(slide, x, y, w, h, fill_rgb, alpha=None):
    from pptx.util import Inches
    shape = slide.shapes.add_shape(1, x, y, w, h)   # MSO_SHAPE_TYPE.RECTANGLE = 1
    shape.line.fill.background()                      # no border
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_rgb
    return shape

def add_textbox(slide, x, y, w, h, text, font_size=18, bold=False,
                color=WHITE, align=PP_ALIGN.LEFT, wrap=True,
                italic=False, v_anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = v_anchor
    tf.margin_left = 0; tf.margin_right = 0
    tf.margin_top = 0;  tf.margin_bottom = 0
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.size = Pt(font_size)
    r.font.bold = bold
    r.font.italic = italic
    r.font.color.rgb = color
    r.font.name = "Calibri"
    return tb, tf

def add_slide_chrome(slide, title_text, subtitle_text=""):
    """Add the common top bar + title."""
    # Full background
    add_rect(slide, 0, 0, prs.slide_width, prs.slide_height, LIGHT_GREY)
    # Top banner
    add_rect(slide, 0, 0, prs.slide_width, Inches(1.15), DARK_NAVY)
    # Left accent stripe
    add_rect(slide, 0, Inches(1.15), Inches(0.07), prs.slide_height - Inches(1.15), ACCENT_TEAL)
    # Title text
    add_textbox(slide, Inches(0.2), Inches(0.12), Inches(12.5), Inches(0.75),
                title_text, font_size=30, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle_text:
        add_textbox(slide, Inches(0.2), Inches(0.72), Inches(12.5), Inches(0.36),
                    subtitle_text, font_size=14, bold=False, color=ACCENT_TEAL,
                    align=PP_ALIGN.LEFT)
    # Bottom accent bar
    add_rect(slide, 0, Inches(7.2), prs.slide_width, Inches(0.3), MID_BLUE)
    add_textbox(slide, Inches(0.2), Inches(7.22), Inches(10), Inches(0.26),
                "Sources: Harrison's Principles of Internal Medicine 22E | Fuster & Hurst's The Heart 15E | Frameworks for Internal Medicine",
                font_size=8, color=WHITE, align=PP_ALIGN.LEFT)

def add_bullets(slide, x, y, w, h, items, font_size=16, color=TEXT_DARK,
                bullet_color=ACCENT_TEAL, indent=0):
    """Add a bulleted list as stacked textboxes for easy formatting."""
    from pptx.oxml.ns import qn
    import lxml.etree as etree
    tb = slide.shapes.add_textbox(x, y, w, h)
    tf = tb.text_frame
    tf.word_wrap = True
    tf.margin_left = Inches(0.08)
    tf.margin_top  = Inches(0.05)
    first = True
    for item in items:
        if first:
            p = tf.paragraphs[0]
            first = False
        else:
            p = tf.add_paragraph()
        p.space_before = Pt(4)
        p.space_after  = Pt(2)
        # bullet dot
        run_dot = p.add_run()
        run_dot.text = "● "
        run_dot.font.size = Pt(font_size - 2)
        run_dot.font.color.rgb = bullet_color
        run_dot.font.name = "Calibri"
        # text
        run_txt = p.add_run()
        run_txt.text = item
        run_txt.font.size = Pt(font_size)
        run_txt.font.color.rgb = color
        run_txt.font.name = "Calibri"
    return tb

def stat_box(slide, x, y, w, h, label, value, val_color=YELLOW_HL):
    """A highlighted stat card."""
    add_rect(slide, x, y, w, h, MID_BLUE)
    add_textbox(slide, x + Inches(0.1), y + Inches(0.05), w - Inches(0.2), Inches(0.45),
                value, font_size=28, bold=True, color=val_color,
                align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)
    add_textbox(slide, x + Inches(0.1), y + Inches(0.52), w - Inches(0.2), Inches(0.38),
                label, font_size=12, bold=False, color=WHITE,
                align=PP_ALIGN.CENTER, v_anchor=MSO_ANCHOR.MIDDLE)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — Title Slide
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, prs.slide_width, prs.slide_height, DARK_NAVY)
# Decorative teal band
add_rect(s, 0, Inches(3.2), prs.slide_width, Inches(0.08), ACCENT_TEAL)
add_rect(s, 0, Inches(5.4), prs.slide_width, Inches(0.05), MID_BLUE)

add_textbox(s, Inches(1), Inches(1.3), Inches(11), Inches(1.2),
            "CARDIOEMBOLIC STROKE",
            font_size=48, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

add_textbox(s, Inches(1), Inches(2.6), Inches(11), Inches(0.5),
            "Etiology  |  Symptoms & Signs  |  Relevant Findings  |  Treatment",
            font_size=20, bold=False, color=ACCENT_TEAL, align=PP_ALIGN.CENTER)

add_textbox(s, Inches(2), Inches(3.5), Inches(9), Inches(0.4),
            "Cardioembolic stroke accounts for ~20–25% of all ischemic strokes",
            font_size=16, italic=True, color=LIGHT_GREY, align=PP_ALIGN.CENTER)

# Stat boxes on title slide
stat_box(s, Inches(1.5),  Inches(4.4), Inches(2.2), Inches(1.0), "of all ischemic strokes", "~20%")
stat_box(s, Inches(4.1),  Inches(4.4), Inches(2.2), Inches(1.0), "annual stroke risk in AF", "~5%")
stat_box(s, Inches(6.7),  Inches(4.4), Inches(2.2), Inches(1.0), "risk reduction with OAC", "~67%")
stat_box(s, Inches(9.3),  Inches(4.4), Inches(2.2), Inches(1.0), "PFO in general population", "~15%")

add_rect(s, 0, Inches(7.2), prs.slide_width, Inches(0.3), MID_BLUE)
add_textbox(s, Inches(0.2), Inches(7.22), Inches(10), Inches(0.26),
            "Sources: Harrison's 22E | Fuster & Hurst's The Heart 15E | Frameworks for Internal Medicine",
            font_size=8, color=WHITE, align=PP_ALIGN.LEFT)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — Overview & Pathophysiology
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_slide_chrome(s, "Overview & Pathophysiology", "Mechanism of cardioembolic stroke")

# Left column
add_rect(s, Inches(0.15), Inches(1.25), Inches(6.2), Inches(5.75), WHITE)
add_textbox(s, Inches(0.25), Inches(1.35), Inches(6.0), Inches(0.4),
            "Definition & Mechanism", font_size=16, bold=True, color=MID_BLUE)

bullets_l = [
    "Cardioembolism: ~20% of all ischemic strokes",
    "Thrombus forms on atrial/ventricular wall or left heart valves → detaches → embolises into arterial circulation",
    "Thrombus may fragment/lyse quickly → TIA; prolonged occlusion → stroke",
    "Embolic strokes: sudden onset with MAXIMUM neurologic deficit at onset",
    "Petechial haemorrhages may follow reperfusion (distinguish from frank haemorrhagic transformation)",
    "Most common lodgement sites: ICA, MCA, PCA, and their branches",
    "Large embolus (3–4 mm) occludes MCA stem → large infarct (deep grey + white matter + cortex)",
    "Multiple-territory infarction is a hallmark (unlike thrombotic strokes)"
]
add_bullets(s, Inches(0.2), Inches(1.8), Inches(6.1), Inches(5.0), bullets_l, font_size=14)

# Right column
add_rect(s, Inches(6.55), Inches(1.25), Inches(6.6), Inches(5.75), WHITE)
add_textbox(s, Inches(6.65), Inches(1.35), Inches(6.4), Inches(0.4),
            "Embolism Mechanisms", font_size=16, bold=True, color=MID_BLUE)

mechanisms = [
    ("Cardioembolism", "Large cardiac output → brain; thrombus originates in heart chambers"),
    ("Artery-to-Artery", "Atherosclerotic plaque fragments travel downstream"),
    ("Paradoxical Embolism", "Venous thrombus crosses to arterial circulation via PFO or ASD"),
    ("Fat / Tumour Emboli", "Rare; fat (fractures), atrial myxoma, bacterial vegetations"),
]
ypos = Inches(1.85)
for title, desc in mechanisms:
    add_rect(s, Inches(6.6), ypos, Inches(6.4), Inches(0.28), ACCENT_TEAL)
    add_textbox(s, Inches(6.7), ypos, Inches(6.2), Inches(0.28),
                title, font_size=13, bold=True, color=WHITE)
    add_textbox(s, Inches(6.7), ypos + Inches(0.3), Inches(6.2), Inches(0.42),
                desc, font_size=12, color=TEXT_DARK)
    ypos += Inches(0.82)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — Etiology
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_slide_chrome(s, "Etiology", "Major cardiac sources of cerebral embolism")

# Two-column layout
# Col 1 — High risk
add_rect(s, Inches(0.15), Inches(1.25), Inches(6.0), Inches(5.75), WHITE)
add_rect(s, Inches(0.15), Inches(1.25), Inches(6.0), Inches(0.42), MID_BLUE)
add_textbox(s, Inches(0.25), Inches(1.27), Inches(5.8), Inches(0.38),
            "HIGH RISK — Anticoagulation Standard of Care", font_size=13, bold=True, color=WHITE)

high_risk = [
    "Non-rheumatic (non-valvular) atrial fibrillation — MOST COMMON cause overall",
    "Atrial flutter",
    "Left atrial / left atrial appendage thrombus",
    "Left ventricular thrombus",
    "Recent anterior MI (<4 weeks) with LV thrombus",
    "Left ventricular assist device (LVAD)",
    "Rheumatic mitral stenosis with AF / recurrent embolic events",
    "Mechanical prosthetic valves (aortic or mitral)",
    "Ischaemic cardiomyopathy with very low EF (<15%)",
]
add_bullets(s, Inches(0.2), Inches(1.75), Inches(5.9), Inches(5.0), high_risk, font_size=13)

# Col 2 — Moderate / other
add_rect(s, Inches(6.45), Inches(1.25), Inches(6.75), Inches(5.75), WHITE)
add_rect(s, Inches(6.45), Inches(1.25), Inches(6.75), Inches(0.42), ACCENT_TEAL)
add_textbox(s, Inches(6.55), Inches(1.27), Inches(6.55), Inches(0.38),
            "MODERATE / SPECIAL RISK", font_size=13, bold=True, color=WHITE)

mod_risk = [
    "Infective endocarditis (antibiotics; anticoagulation CONTRAINDICATED)",
    "Non-bacterial thrombotic endocarditis (marantic) — especially with hypercoagulability",
    "Papillary fibroelastoma (anticoag if surgery contraindicated)",
    "Atrial myxoma (surgical resection — anticoag contraindicated)",
    "Mitral valve prolapse (anticoag only if AF present; aspirin if cryptogenic TIA)",
    "Bioprosthetic aortic/mitral valve — antiplatelet standard of care",
    "Patent foramen ovale (PFO) — cryptogenic stroke, closure if causative",
    "Aortic arch mobile atheroma — aspirin or OAC",
    "Mitral annular calcification — aspirin unless AF (then OAC)",
    "Paradoxical embolism via ASD / pulmonary AVM",
]
add_bullets(s, Inches(6.5), Inches(1.75), Inches(6.65), Inches(5.0), mod_risk, font_size=13)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — Symptoms & Signs
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_slide_chrome(s, "Symptoms & Signs", "Clinical presentation of cardioembolic stroke")

# Top banner note
add_rect(s, Inches(0.15), Inches(1.28), Inches(13.0), Inches(0.42), MID_BLUE)
add_textbox(s, Inches(0.3), Inches(1.3), Inches(12.7), Inches(0.38),
            "KEY FEATURE: Sudden onset with maximum deficit at onset; may involve multiple vascular territories simultaneously",
            font_size=13, bold=True, color=YELLOW_HL, align=PP_ALIGN.LEFT)

# Three columns: MCA, ICA/ACA, PCA/Posterior
col_w = Inches(4.15)
cols = [
    {
        "title": "MCA Territory",
        "items": [
            "Contralateral hemiplegia (face + arm > leg)",
            "Contralateral hemisensory loss",
            "Homonymous hemianopia",
            "Aphasia (dominant hemisphere — Broca, Wernicke or global)",
            "Neglect / anosognosia (non-dominant)",
            "Gaze deviation towards infarct side",
            "Dysarthria",
            "Large MCA: impaired consciousness, cerebral oedema (malignant MCA syndrome)",
        ]
    },
    {
        "title": "ICA / ACA Territory",
        "items": [
            "ICA occlusion: combined MCA + ACA territory deficits",
            "Monocular blindness (amaurosis fugax) — ophthalmic artery",
            "ACA: contralateral leg > arm weakness",
            "ACA: abulia, personality change, urinary incontinence",
            "Carotid terminus occlusion: large hemispheric infarct ± herniation",
        ]
    },
    {
        "title": "Posterior / Vertebrobasilar",
        "items": [
            "PCA: contralateral hemianopia, visual agnosia, alexia",
            "Basilar apex emboli: bilateral signs (hallmark), sudden coma",
            "Weber syndrome (CN III palsy + contralateral hemiplegia)",
            "Cerebellar infarct: ataxia, vertigo, nausea, vomiting",
            "Lateral medullary (Wallenberg) syndrome",
            "Diplopia, nystagmus, dysphagia, dysarthria",
            "Top-of-basilar: hypersomnolence, pupillary abnormalities",
        ]
    }
]
x = Inches(0.15)
for col in cols:
    add_rect(s, x, Inches(1.78), col_w, Inches(5.3), WHITE)
    add_rect(s, x, Inches(1.78), col_w, Inches(0.38), ACCENT_TEAL)
    add_textbox(s, x + Inches(0.1), Inches(1.80), col_w - Inches(0.2), Inches(0.34),
                col["title"], font_size=13, bold=True, color=WHITE)
    add_bullets(s, x + Inches(0.05), Inches(2.2), col_w - Inches(0.1), Inches(4.8),
                col["items"], font_size=12)
    x += col_w + Inches(0.22)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — Relevant Findings (Investigations)
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_slide_chrome(s, "Relevant Findings & Investigations", "Diagnostic workup for cardioembolic stroke")

invest = [
    {
        "cat": "Neuroimaging",
        "items": [
            "CT brain (non-contrast): first-line — exclude haemorrhage; early ischaemia in <60% within 6 h",
            "MRI DWI: most sensitive for acute infarct; shows restricted diffusion within minutes",
            "Multiple cortical / subcortical infarcts in DIFFERENT vascular territories → strongly suggests embolism",
            "Cortical 'wedge' infarcts or 'rosette' haemorrhagic transformation — embolic pattern",
            "MRI FLAIR / GRE: identifies haemorrhagic transformation",
            "CT/MR Angiography: identifies vessel occlusion (MCA, ICA, basilar)",
        ]
    },
    {
        "cat": "Cardiac Investigations",
        "items": [
            "12-lead ECG: AF, flutter, recent MI (Q waves), LV hypertrophy",
            "Prolonged cardiac monitoring (Holter 24–72 h or implantable loop recorder): detect paroxysmal AF",
            "Transthoracic echocardiogram (TTE): LV thrombus, wall motion abnormality, valve disease, EF",
            "Transesophageal echocardiogram (TEE): superior for LAA thrombus, PFO, aortic arch atheroma, vegetations",
            "Bubble-contrast echo (agitated saline): detects right-to-left shunt (PFO/ASD)",
            "Transcranial Doppler + bubble study: detect right-to-left shunt (microemboli)",
            "Troponin / BNP: myocardial injury, heart failure",
        ]
    },
    {
        "cat": "Laboratory & Other",
        "items": [
            "CBC, PT/INR, aPTT, glucose: baseline coagulation, exclude metabolic causes",
            "Hypercoagulability screen (protein C/S, antiphospholipid antibodies) in young/cryptogenic stroke",
            "CHA₂DS₂-VASc score: quantify stroke risk in AF to guide anticoagulation",
            "Carotid duplex / CTA: exclude large-vessel atherosclerosis as alternative source",
            "Blood cultures: if infective endocarditis suspected",
            "ESR / CRP / ANA: vasculitis / inflammatory causes in young patients",
        ]
    }
]

# Three rows
ypos = Inches(1.28)
for idx, inv in enumerate(invest):
    add_rect(s, Inches(0.15), ypos, Inches(13.0), Inches(0.35), MID_BLUE if idx % 2 == 0 else ACCENT_TEAL)
    add_textbox(s, Inches(0.3), ypos + Inches(0.03), Inches(12.7), Inches(0.30),
                inv["cat"], font_size=14, bold=True, color=WHITE)
    add_rect(s, Inches(0.15), ypos + Inches(0.35), Inches(13.0), Inches(1.5), WHITE)
    add_bullets(s, Inches(0.25), ypos + Inches(0.38), Inches(12.7), Inches(1.4),
                inv["items"], font_size=12)
    ypos += Inches(1.95)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — CHA₂DS₂-VASc Score
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_slide_chrome(s, "CHA₂DS₂-VASc Score", "Stroke risk stratification in non-valvular atrial fibrillation")

# Table
headers = ["Risk Factor", "Points", "Recommendation"]
rows = [
    ("C — Congestive Heart Failure / LV dysfunction", "1", ""),
    ("H — Hypertension", "1", ""),
    ("A₂ — Age ≥ 75 years", "2", ""),
    ("D — Diabetes Mellitus", "1", ""),
    ("S₂ — Prior Stroke / TIA / thromboembolism", "2", ""),
    ("V — Vascular disease (MI, PAD, aortic plaque)", "1", ""),
    ("A — Age 65–74 years", "1", ""),
    ("Sc — Sex category (Female)", "1", ""),
]
recs = [
    ("Score 0", "No antithrombotic OR aspirin"),
    ("Score 1", "Aspirin OR oral anticoagulant (OAC)"),
    ("Score ≥ 2", "OAC (preferred DOAC over warfarin)"),
]

# Left: table
add_rect(s, Inches(0.15), Inches(1.28), Inches(7.5), Inches(5.72), WHITE)
add_rect(s, Inches(0.15), Inches(1.28), Inches(7.5), Inches(0.38), DARK_NAVY)
hx = Inches(0.2)
for h, hw in zip(headers, [Inches(4.5), Inches(0.9), Inches(1.8)]):
    add_textbox(s, hx, Inches(1.3), hw, Inches(0.34), h, font_size=13, bold=True, color=WHITE)
    hx += hw

yrow = Inches(1.7)
for i, (rf, pts, _) in enumerate(rows):
    bg = LIGHT_GREY if i % 2 == 0 else WHITE
    add_rect(s, Inches(0.15), yrow, Inches(7.5), Inches(0.52), bg)
    add_textbox(s, Inches(0.25), yrow + Inches(0.05), Inches(4.4), Inches(0.44),
                rf, font_size=12, color=TEXT_DARK)
    add_textbox(s, Inches(4.75), yrow + Inches(0.05), Inches(0.85), Inches(0.44),
                pts, font_size=14, bold=True, color=MID_BLUE, align=PP_ALIGN.CENTER)
    yrow += Inches(0.53)

# Right: recommendations
add_rect(s, Inches(7.85), Inches(1.28), Inches(5.35), Inches(5.72), WHITE)
add_rect(s, Inches(7.85), Inches(1.28), Inches(5.35), Inches(0.38), ACCENT_TEAL)
add_textbox(s, Inches(7.95), Inches(1.30), Inches(5.15), Inches(0.34),
            "Treatment Recommendations", font_size=14, bold=True, color=WHITE)
ypos2 = Inches(1.75)
for score, rec in recs:
    add_rect(s, Inches(7.9), ypos2, Inches(5.2), Inches(0.85), MID_BLUE)
    add_textbox(s, Inches(8.0), ypos2 + Inches(0.06), Inches(5.0), Inches(0.35),
                score, font_size=14, bold=True, color=YELLOW_HL)
    add_textbox(s, Inches(8.0), ypos2 + Inches(0.42), Inches(5.0), Inches(0.38),
                rec, font_size=12, color=WHITE)
    ypos2 += Inches(1.0)

# Max score note
add_textbox(s, Inches(7.9), ypos2 + Inches(0.3), Inches(5.15), Inches(0.4),
            "Maximum score: 9\nFemale sex alone (score=1) does NOT mandate anticoagulation",
            font_size=11, italic=True, color=MID_BLUE)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — Treatment: Acute Management
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_slide_chrome(s, "Treatment: Acute Management", "Immediate intervention in cardioembolic stroke")

boxes = [
    {
        "title": "1. IV Thrombolysis (tPA)",
        "color": MID_BLUE,
        "items": [
            "Alteplase 0.9 mg/kg IV (max 90 mg) — 10% bolus, remainder over 60 min",
            "Window: ≤4.5 hours from symptom onset (selected patients up to 9 h with imaging mismatch)",
            "DO NOT delay for cardiac workup if within window",
            "Haemorrhagic transformation risk is higher in cardioembolic stroke",
            "Tenecteplase: emerging as equivalent alternative (single bolus)",
        ]
    },
    {
        "title": "2. Mechanical Thrombectomy (EVT)",
        "color": ACCENT_TEAL,
        "items": [
            "Indicated for LVO (large vessel occlusion: ICA, M1/M2 MCA, basilar)",
            "Window: up to 24 h with perfusion imaging selection (DAWN / DEFUSE-3 criteria)",
            "Stent-retriever or aspiration technique",
            "Can be combined with IV tPA (drip-and-ship)",
            "Cardioembolic clots: often red/fibrin-rich — may respond well to retrieval",
        ]
    },
    {
        "title": "3. General Supportive Care",
        "color": MID_BLUE,
        "items": [
            "Permissive hypertension: allow BP up to 220/120 mmHg (unless tPA given: <180/105)",
            "Normoglycaemia: treat hypo/hyperglycaemia (glucose 140–180 mg/dL)",
            "Supplemental O₂ only if SpO₂ <94%; avoid routine O₂",
            "Fever management: paracetamol ± cooling (target normothermia)",
            "DVT prophylaxis: pneumatic compression stockings acutely",
            "Swallow assessment before oral intake",
            "Stroke unit admission: reduces mortality and disability",
        ]
    }
]

x = Inches(0.15)
bw = Inches(4.28)
for box in boxes:
    add_rect(s, x, Inches(1.28), bw, Inches(5.72), WHITE)
    add_rect(s, x, Inches(1.28), bw, Inches(0.4), box["color"])
    add_textbox(s, x + Inches(0.1), Inches(1.30), bw - Inches(0.2), Inches(0.36),
                box["title"], font_size=13, bold=True, color=WHITE)
    add_bullets(s, x + Inches(0.05), Inches(1.73), bw - Inches(0.1), Inches(5.15),
                box["items"], font_size=12)
    x += bw + Inches(0.18)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — Treatment: Secondary Prevention & Antithrombotic Therapy
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_slide_chrome(s, "Treatment: Secondary Prevention", "Antithrombotic therapy & anticoagulation")

# Key messages banner
add_rect(s, Inches(0.15), Inches(1.28), Inches(13.0), Inches(0.4), DARK_NAVY)
add_textbox(s, Inches(0.3), Inches(1.30), Inches(12.7), Inches(0.36),
            "OAC reduces recurrent stroke by ~67% in NVAF | DOACs preferred over VKA (warfarin) in most cases",
            font_size=13, bold=True, color=YELLOW_HL, align=PP_ALIGN.LEFT)

# Two columns
add_rect(s, Inches(0.15), Inches(1.72), Inches(6.4), Inches(5.28), WHITE)
add_rect(s, Inches(0.15), Inches(1.72), Inches(6.4), Inches(0.38), MID_BLUE)
add_textbox(s, Inches(0.25), Inches(1.74), Inches(6.2), Inches(0.34),
            "Direct Oral Anticoagulants (DOACs)", font_size=14, bold=True, color=WHITE)

doacs = [
    "Dabigatran (thrombin inhibitor): 110 mg or 150 mg BD — non-inferior to warfarin; 150 mg BD superior; no INR monitoring",
    "Apixaban 5 mg BD (factor Xa inhibitor): superior to warfarin (1.27% vs 1.6% endpoint); less major bleeding",
    "Rivaroxaban 20 mg OD (factor Xa inhibitor): non-inferior to warfarin; less intracranial haemorrhage",
    "Edoxaban 60 mg OD (factor Xa inhibitor): non-inferior to warfarin",
    "Reversal agents: Idarucizumab (dabigatran); Andexanet alfa (apixaban, rivaroxaban)",
    "DOACs require no routine INR monitoring; minimal dietary interaction",
    "AVOID DOACs in: mechanical heart valves, moderate-severe rheumatic mitral stenosis",
]
add_bullets(s, Inches(0.2), Inches(2.14), Inches(6.3), Inches(4.75), doacs, font_size=12)

add_rect(s, Inches(6.75), Inches(1.72), Inches(6.4), Inches(5.28), WHITE)
add_rect(s, Inches(6.75), Inches(1.72), Inches(6.4), Inches(0.38), ACCENT_TEAL)
add_textbox(s, Inches(6.85), Inches(1.74), Inches(6.2), Inches(0.34),
            "Vitamin K Antagonists & Special Situations", font_size=14, bold=True, color=WHITE)

vka = [
    "Warfarin (VKA): INR 2–3 for NVAF; still gold standard for mechanical valves",
    "Mechanical aortic valve (bileaflet): VKA INR 2.5–3.5",
    "Mechanical mitral valve: VKA INR 3.0 (range 2.5–3.5)",
    "Mechanical valve + AF / low EF: Aspirin + VKA INR 3.0",
    "If OAC not tolerated (bleeding risk): Clopidogrel + Aspirin (ACTIVE-A — more effective than aspirin alone but ↑ bleeding)",
    "LAA occlusion device (Watchman): non-inferior to DOACs in high bleeding-risk patients",
    "Infective endocarditis: antibiotics; anticoagulation CONTRAINDICATED",
    "Timing to restart OAC after stroke: typically 2–4 weeks (varies by infarct size & haemorrhagic transformation risk)",
]
add_bullets(s, Inches(6.8), Inches(2.14), Inches(6.3), Inches(4.75), vka, font_size=12)


# ═══════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — Summary
# ═══════════════════════════════════════════════════════════════════════════════
s = prs.slides.add_slide(blank)
add_rect(s, 0, 0, prs.slide_width, prs.slide_height, DARK_NAVY)
add_rect(s, 0, Inches(1.1), prs.slide_width, Inches(0.06), ACCENT_TEAL)
add_rect(s, 0, Inches(6.5), prs.slide_width, Inches(0.06), MID_BLUE)

add_textbox(s, Inches(1), Inches(0.2), Inches(11), Inches(0.8),
            "SUMMARY: CARDIOEMBOLIC STROKE",
            font_size=34, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

summary_items = [
    ("Incidence", "~20–25% of all ischaemic strokes; MOST COMMON embolic stroke type"),
    ("Onset", "Sudden, MAXIMAL deficit at onset; multiple territory involvement is hallmark"),
    ("Top Aetiology", "Non-valvular atrial fibrillation (AF) — annual stroke risk ~5%"),
    ("Other Sources", "LV thrombus, MI, prosthetic valves, endocarditis, PFO, cardiomyopathy"),
    ("Key Investigations", "MRI DWI + MRA, ECG (prolonged monitoring), TTE/TEE, bubble echo, CHA₂DS₂-VASc"),
    ("Acute Treatment", "IV tPA (≤4.5 h) and/or mechanical thrombectomy for LVO (up to 24 h)"),
    ("Secondary Prevention", "OAC (DOACs preferred) for AF: reduces recurrence by ~67%"),
    ("Special Cases", "Mechanical valves → warfarin; Infective endocarditis → antibiotics only"),
]

x_positions = [Inches(0.2), Inches(6.7)]
y_start = Inches(1.25)
for i, (key, val) in enumerate(summary_items):
    col = i % 2
    row = i // 2
    xp = x_positions[col]
    yp = y_start + row * Inches(1.22)
    add_rect(s, xp, yp, Inches(6.2), Inches(1.1), MID_BLUE)
    add_rect(s, xp, yp, Inches(1.8), Inches(1.1), ACCENT_TEAL)
    add_textbox(s, xp + Inches(0.1), yp + Inches(0.2), Inches(1.6), Inches(0.65),
                key, font_size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER,
                v_anchor=MSO_ANCHOR.MIDDLE)
    add_textbox(s, xp + Inches(1.9), yp + Inches(0.08), Inches(4.2), Inches(0.94),
                val, font_size=12, color=WHITE, v_anchor=MSO_ANCHOR.MIDDLE)

add_rect(s, 0, Inches(7.2), prs.slide_width, Inches(0.3), MID_BLUE)
add_textbox(s, Inches(0.2), Inches(7.22), Inches(10), Inches(0.26),
            "Sources: Harrison's Principles of Internal Medicine 22E | Fuster & Hurst's The Heart 15E | Frameworks for Internal Medicine",
            font_size=8, color=WHITE, align=PP_ALIGN.LEFT)


# ── Save ──────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/cardioembolic-stroke/Cardioembolic_Stroke.pptx"
prs.save(out_path)
print(f"Saved: {out_path}")