Hospital Medicine

Vascular Neurology

Questions discussed in this category

Would you consider giving thrombolytic therapy for patients with acute vision loss concerning for CRAO based on history and within the window before any ophthalmological assessment and confirmation?

Would your approach differ through telemedicine for small ERs without access to onsite ophthalmology or neurology?

3 Answers available

Regarding CVST, what protocol of heparin dosing do you regularly use and does it change depending on clot burden/ICH status?

Is there any evidence supporting the use of heparin boluses?

3 Answers available

Do you use dual anti-platelet therapy inpatients with low NIHSS who have had bilateral brainstem strokes?

1 Answer available

How to approach reversal of TNK in hemorrhagic conversion of ischemic stroke?

Considering the short half-life, at what point would it be deemed too late to administer any reversal agent, and to consider withholding it?

2 Answers available

How do you manage headaches in stroke patients?

Is there a difference in headache management in ischemic stroke versus hemorrhagic stroke? How to best manage patients with underlying migraine who...

2 Answers available

How do you decide when to use andexanet (ANDEXXA) for intracranial hemorrhage associated with factor Xa inhibitors?

In light of ANNEXA-I RCT results: Connolly et al., PMID 38749032.

1 Answer available

Do all patients referred for acute symptoms of TIA or minor stroke require additional imaging with CT/MR angiography, in addition to admission/observation?

Can some patients referred for TIA/stroke symptoms who have at the time of ER referral, a normal neurological exam be discharged with outpatient worku...

3 Answers available

How would you determine the safety of anticoagulation in patients with evidence of cerebral microhemorrhages who present with acute stroke secondary to cardioembolism?

4 Answers available

Do you ever use amantadine or modafinil to aid in the rehabilitation of patients with ischemic strokes?

In patients who have decreased arousal after ischemic stroke, do you use amantadine or modafinil to aid with wakefulness and interaction with therapy ...

3 Answers available

How would you manage a CVST secondary to a traumatic brain injury with the presence of intracranial hemorrhage?

When would you consider using anticoagulation and for how long?

4 Answers available

When do you consider lumbar spinal fluid drainage after acute spinal cord injury?

1 Answer available

What is your approach to management and surveillance in low grade traumatic blunt ICA injury?

1 Answer available

How would you approach antithrombotic therapy in patients with acute ischemic infarcts and a non-occlusive intracranial thrombus?

Would you adjust your approach based on the infarct size, symptom severity, or stroke etiology?

3 Answers available

What is your approach to managing patients who initially present with symptomatic intracranial large vessel occlusion but subsequently experience resolution of symptoms or become non-disabling before any intervention?

Would your management be different if the LVO was found on imaging without preceding associated symptoms?

4 Answers available

How does premorbid dementia affect your decision to offer acute stroke intervention?

In light of the publication by Ganesh et al., PMID 39503052.

4 Answers available

Does TpA or TNK cause acute post infusion severe headache with no intracranial bleed?

1 Answer available

Do you recommend CT perfusion in patients presenting with symptoms of acute stroke before 6 hours?

7 Answers available

What blood pressure targets do you enforce in the first 24-48 hours in a patient who develops an intracranial hemorrhage after mechanical thrombectomy?

Blood pressure targets for ischemic stroke and intracerebral hemorrhage are described in several guidelines. However, in patients with acute stroke wh...

2 Answers available

How do you medically manage acute basilar artery occlusion in patients with low NIHSS who are not candidates for EVT but at risk for deterioration?

2 Answers available

When do you recommend hyperacute MRI for patients with wake-up stroke?

2 Answers available

Do you typically load DAPT in patients with ICAD?

2 Answers available

How do you manage patients with embolic stroke of an undetermined source and a papillary fibroelastoma found on an echocardiogram?

Are there specific mass features that would influence your treatment decision?

1 Answer available

Will you begin considering TNK for ischemic stroke patients with a large vessel occlusion presenting outside the 4.5-hour window?

In light of TIMELESS and TRACE-III trials.

2 Answers available

Should one perform a subsequent screening CTA or MRA head for mycotic aneurysm after cardio-embolic strokes in a setting of endocarditis with initial unremarkable CTA or MRA head/neck?

2 Answers available

Is there a good rationale for using vasopressors/induced hypertension in a patient with fluctuating neurologic deficits from symptomatic intracranial stenosis?

3 Answers available

What is your approach to the management of asymptomatic intracranial atherosclerosis discovered during the workup of an acute stroke?

Does it influence your choice of antithrombotic therapy? Do you perform serial follow-up imaging?

3 Answers available

What is your strategy for treating persistent headaches in the aftermath of subarachnoid hemorrhage?

Does your strategy change depending on whether or not it is a secured or unsecured aneurysmal SAH?

4 Answers available

Would you recommend TNK or DAPT in patients with stroke-like symptoms and NIHSS less than 5 presenting within 4.5 hours?

4 Answers available

Would you administer IV thrombolysis in a patient presenting with disabling stroke symptoms while on anti-amyloid therapy?

4 Answers available

Would you give TNK or IVT to a patient with proximal occlusion and an NIHSS of 0-3 (non-disabling)?

How about a distal occlusion? The patient was initially symptomatic but symptoms improved or mostly resolved.

5 Answers available

How do you acutely manage a free-floating thrombus in a major artery in a patient with a stroke as a result of it?

4 Answers available

What adjustments do you make to a hemodialysis prescription for a patient with a recent stroke?

3 Answers available

Do you routinely screen for sleep apnea in patients with acute ischemic stroke?

3 Answers available

For patients with acute ischemic stroke and BP >185/110, at what point do you consider persistently elevated BP too refractory to safely give thrombolysis?

Current guidelines (AHA, ESO, etc.) are not clear. In addition, if a patient arrives with BP>240 how do you balance the risk of hypoperfusion with ...

4 Answers available

What is the recommended approach for extracranial bleeding after tPA?

Fibrinogen level >200.

2 Answers available

For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention?

For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention? POD 5? P...

2 Answers available

What blood pressure goals do you typically target for patients in the immediate post thrombectomy period?

2 Answers available

Do you typically recommend inpatient stroke evaluation for patients with incidentally found asymptomatic stroke on outpatient imaging?

For patients undergoing outpatient MR imaging for other indications who have instantly found acute stroke, do you typically recommend the patient be a...

5 Answers available

How long do you wait before foley or IV placement in patients who have recieved TNK or TPA?

3 Answers available

How would you manage anti-platelet therapy in patients presenting with ischemic stroke and have a history of von Willebrand disease?

1 Answer available

Would you give IV thrombolysis to a patient presenting with acute disabling stroke symptoms after a TAVI procedure?

1 Answer available

When do you start anticoagulation in patients with endocarditis and evidence of mycotic aneursym?

3 Answers available

Do you typically recommend four factor prothrombin complex concentrate versus fresh frozen plasma for INR correction in patients with vitamin K antagonist associated spontaneous ICH?

4 Answers available

Is angioedema secondary to IV tPA considered an absolute contraindication for tPA in future?

3 Answers available

Do you typically recommend platelet transfusions in patients with spontaneous ICH?

Do you have a particular cutoff?

2 Answers available

Do you typically recommend CT angiogram and CT venogram to assess for patients with lobar spontaneous ICH?

2 Answers available

Do you always pursue stroke work up in patients diagnosed with transient global amnesia?

For patients clinically presenting with Transient Global Amnesia and no other focal neurologic deficits, do you always pursue work up to rule out stro...

8 Answers available

What is your approach for a patient with an acute ischemic stroke caused by an aortic thrombus?

2 Answers available

What is your approach to a patient who has an ischemic stroke while on clopidogrel despite strict compliance and normal results on clopidogrel response assay?

5 Answers available

When do you start anticoagulation in a patient with cardioembolic CVA secondary to new onset atrial fibrillation with hemorrhagic conversion?

1 Answer available

How do you determine timing and frequency of stability scans for a patient with spontaneous, non-aneurysmal intracerebral hemorrhage?

What factors influence your thinking?

1 Answer available

Do you use a combination of anticoagulant and antiplatelet therapy for treating intraluminal internal cerebral artery thrombus causing stroke?

For what duration do you use therapy?

1 Answer available

Do you treat cerebral vein thrombosis with parenchymal hemorrhage using full dose heparin protocol rather than the high risk protocol?

1 Answer available

Do you start anticoagulation in a patient with infective endocarditis who also has atrial fibrillation and stroke?

1 Answer available

How do you treat patients with symptoms of acute ischemic stroke who have an allergic reaction to alteplase?

How would you treat patients with symptoms of AIS who have an allergic reaction to TPA with no evidence of large vessel occlusion on imaging? What nex...

1 Answer available

When do you consider starting hypertonic saline solution in patients with an acute ischemic stroke?

1 Answer available

How do you approach management of cerebral venous sinus thrombosis in a patient with severe thrombocytopenia?

1 Answer available

How do you determine the timing of anticoagulation for patients with large MCA strokes secondary to atrial fibrillation?

1 Answer available

In what clinical settings is acute ICH clot removal recommended?

1 Answer available