Neuro-critical care&nbsp;&nbsp;&nbsp;

Do you use or recommend clinical severity scores or other parameters in helping prognostication in patients with refractory status epilepticus?

What is your hemoglobin target for PRBC transfusion in cases of acute brain injury?

Have recent trials (TRAIN trial and HEMOTION trial) influenced your approach?

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...

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?

In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD? How frequently do you monitor osmolarity?

In what clinical situation do you use Botox in patients with increased salivation?

How do you decide on the treatment target of burst suppression pattern vs seizure cessation for patients with status epilepticus?

Would you recommend a neck soft collar after a cervical internal carotid artery dissection?

If so, what is the typical duration?

What is the expected timeframe one would expect to see paroxysmal sympathetic hyperactivity/sympathetic storming persist post-traumatic brain injury?

For example, in the setting of TBI, how do you guide the duration of the medical treatment?

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

When do you consider nerve blocks for headache management in patients admitted to the neuro-intensive care unit with subarachnoid hemorrhage?

When would you consider neuro-stimulants in post-stroke patients?

Is there management guidance on when to start after stroke onset?

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

In which patients do you recommend craniectomy-watch after acute stroke?

Can bleeding risk when switching from VKA treatment to a NOAC in frail, elderly patients be accurately compared if individual times in therapeutic range while on VKA treatment are not captured?

Individual times in the therapeutic range while on VKA treatment was not registered in FRAIL-AF.

When do you use MRI to evaluate patients with spontaneous subdural hemorrhage?

In light of the evidence associating cerebral amyloid angiopathy (CAA) with subdural hemorrhage; Rivier et al., PMID 38147345.

In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?

In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...

Would you avoid the use of keppra in patients with TBI due to concerns for worsening agitation?

In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?

What are the sources for this and are they reliable by today’s standards? Numerous case series report various abnormal movements but how reliabl...

What is your approach to monitoring the neurologic status of a patient with a traumatic brain injury requiring burst suppression for status epilepticus?

E.g., a patient has an intracranial hemorrhage after TBI with convulsive status epilepticus.

How many times one can use IVIG in GBS?

Plasmapheresis first or IVIG first in GBS? What other treatment options are there for severe disabling GBS?

How do you prescribe ketamine for treatment of refractory status epilepticus, and what is its efficacy?

Would you change an elderly, frail patient with atrial fibrillation who is already on a NOAC to VKA treatment?

In FRAIL-AF, switching VKA therapy to a NOAC was associated with higher risk of bleeding in elderly, frail patients.

4 Answers available

Would you attempt a brain MRI in patients who present to the ER with subacute presentation of obstructive hydrocephalus?

Given the risk of elevated ICP, would you attempt a brain MRI to further characterize the lesion? Or would CT imaging suffice prior to intervention?

Which patients presenting with spontaneous ICH should be considered for a diagnostic cerebral angiogram/DSA?

Do you think that home INR monitoring is a feasible option for elderly, frail patients with atrial fibrillation on VKA treatment, given variations in socioeconomic status and access to care?

Do you consider bleeding risk in elderly, frail patients with atrial fibrillation to be similar for all NOACs?

In FRAIL-AF, participants were switched from VKA to dabigatran, rivaroxaban, apixaban, and edoxaban.

Is intracranial hemorrhage a contraindication for valproic acid?

Do you typically recommend anti-epileptic medication in patients with acute multi-compartmental intracranial hemorrhage?

Do patients with NPH/communicating hydrocephalus always require VPS?

Would you recommend temporary EVD or more permanently VPS to lower ICP?

How do you manage autonomic storming in patients with increased intracranial pressure?

Do you perform apnea testing prior to ancillary tests in patients with suspected brain death who are unable to undergo complete brainstem testing?

For patients who are unable to have complete brain stem testing, would you recommend apnea testing prior to ancillary tests in case of suspected brain...

How do you complete brain death testing in patients who cannot tolerate apnea testing and are unable to transport for ancillary testing?

For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...

5 Answers available

How do you evaluate and treat patients with cerebral edema secondary to hyperammonemia?

What modality do you prefer?

Does the overall conclusion of the CHANCE-2 trial make ticagrelor + ASA a worthwhile transition given the data showing cumulative hazard of stroke diverged during the first week and was subsequently similar, which suggests the benefit of ticagrelor over clopidogrel is seen predominantly soon after stroke?

4 Answers available

Is there a risk of CYP2C19 gene testing only being adopted by wealthier health systems, thereby creating a disparity gap in treatment?

What is the cost and accessibility of CYP2C19 gene testing? Does the limited availability of rapid genotyping techniques limit the clinical applicabil...

What is your decision process on decreasing the sodium goal for patients with cerebral edema?

Would you generalize the data from the CHANCE-2 trial to a broader clinic population given that the study was specific to Han Chinese patients?

How do you plan to incorporate the results of the CHANCE-2 trial (Wang et al., PMID 34708996) in your own practice?

Do you recommend genetic testing after a patient on clopidogrel has a stroke based on the results of the CHANCE-2 trial?

Do you routinely obtain an EEG in patients who are admitted with traumatic intra-cerebral hemorrhage?

In what conditions can you see roving eye movements?