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Internal Medicine

Vascular Neurology   

Questions discussed in this category

What is your approach to the treatment of idiopathic intracranial hypertension with transverse sinus stenosis?
Do you favor specific medications or surgical interventions?
3 Answers available
What genetic testing would you consider for recurrent arterial events (cryptogenic strokes, MI) in patients with limited risk factors?
Family history is notable for CVA and early onset MI in nonsmokers, but no personal or family history of VTE. APLS testing is negative. Previously fou...
1 Answer available
Would you consider endovascular thrombectomy for acute stroke patients with large vessel occlusion (non-large core) but with poor functional baseline with mRS 3-4?
Which factors would influence your decision?
3 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
When do you consider testing with stroke gene panels in young stroke patients?
2 Answers available
How do you approach the treatment of biopsy proven ABRA (amyloid beta related angiitis)?
2 Answers available
How do you counsel patients on wearable heart monitor devices when they ask about specific products and diagnostic accuracy of these devices available on the market?
2 Answers available
What treatment do you use for stroke prevention in cervical artery dissection?
In light of the STOP-CAD study
2 Answers available
Does TpA or TNK cause acute post infusion severe headache with no intracranial bleed?
1 Answer available
Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?
Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...
1 Answer available
For which stroke patients, if any, do you recommend implantable loop recorder for long-term cardiac monitoring and why?
It seems clear that longer monitoring yields more AF detected. What is less clear to me is whether all ILR-detected AF is relevant and merits anticoag...
4 Answers available
Do you utilize thrombolytic therapy in patients with CRAO?
2 Answers available
How do you treat patients with stroke thought to be secondary to Lambl excrescence?
2 Answers available
Is there a role for using parenteral anticoagulation for occlusive extensive ICA thrombus with acute onset of symptoms when patients are not candidates for endovascular therapy, such as low NIHSS?
Would having infarct expansion during hospitalization change your approach?
2 Answers available
Do you recommend CT perfusion in patients presenting with symptoms of acute stroke before 6 hours?
7 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 ...
1 Answer available
Is there a stroke volume threshold you use for giving or not giving DAPT for an acute ischemic stroke?
A large stroke in cortical regions might have a low NIHSS, while a small internal capsule lacune might have a large NIHSS. ICH risk is thought to be a...
1 Answer available
What is the value of sending placental pathology in neonatal patients who have suffered an in-utero arterial ischemic stroke?
1 Answer available
How do you manage patients with atrial fibrillation having a thromboembolic infarct despite being on adequate anticoagulation?
Would you recommend left atrial appendage occlusion with or without continuing anticoagulation? In light of Maarse et al., JAMA Neurology 2024.
3 Answers available
How do you determine which patients with ICAS are the best candidates for balloon angioplasty versus those who should continue with aggressive medical management alone?
In light of a recent publication by Sun et al., PMID 39235816 on the BASIS trial for balloon angioplasty for ICAS.
2 Answers available
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? 
2 Answers available
When do you consider starting short-term DAPT in patients who present more than 24 hours after the onset of a high-risk TIA or minor stroke syndrome?
In light of the INSPIRES trial publication.
4 Answers available
In ischemic stroke patients with low LDL levels (<30-50 mg/dl), would you consider lowering LDL levels to lower values without concern for any side effects?
How would you adjust statin therapy in these patients?
3 Answers available
What factors would influence your decision to use or avoid heparin bridging in patients with mechanical heart valves resuming anticoagulation after intracerebral hemorrhage?
In light of a publication by Sakusic et al., PMID 39102615 suggests an increased risk of ICH expansion in patients with heparin bridge compared to sta...
1 Answer 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 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?
2 Answers available
Would you discontinue romosozumab in a patient who develops a hemorrhagic stroke while on therapy?
5 Answers available
What is your approach to secondary stroke prevention in patients with atrial fibrillation and intracranial stenosis (>70%)?
4 Answers available
What would you recommend for long term management of extensive dural venous sinus thrombosis (CVST) in young females when the only provoking risk factor is combined OCP?
Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?
3 Answers available
How do you approach long-term blood pressure parameters in ischemic stroke patients with severe symptomatic intracranial stenosis?
How do you balance between having a higher long-term blood pressure to prevent flow failure and leading to worsening of stenosis or occlusion from the...
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
What is the optimal antithrombotic management, if at all, in patients with incidentally identified findings of multiple silent embolic appearing cerebral infarcts?
2 Answers available
What considerations guide your decision to perform endovascular therapy in stroke involving acute M2 or M3 occlusions?
1 Answer available
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
When do you determine SSRI therapy is unsafe to pursue in such situations?
2 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?
3 Answers available
Does aspirin dose (81 mg vs 325 mg) matter for secondary stroke prevention?
Should some patients get 325 mg instead of 81mg at least for a certain amount of time, such as patients in the acute phase of ischemic stroke or patie...
1 Answer available
When do you recommend hyperacute MRI for patients with wake-up stroke?
2 Answers available
Would you recommend a CT venogram or MR venogram in patients with concern for venous sinus thrombosis?
1 Answer available
Does anyone utilize P2Y12 assays to determine if clopidogrel may be ineffective when used for DAPT?
If yes, if the assay shows they are a non-responder, do you switch to ticagrelor?
2 Answers available
Do you recommend encephaloduroateriosynangiosis in pediatric patients with Moyamoya disease?
1 Answer available
Do you recommend endovascular therapy in patients with isolated posterior cerebral artery stroke?
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?
1 Answer available
Do you recommend any particular type of contraceptive use in young patients with strokes of unclear etiology?
How do you guide what contraceptive type when asked by the medical team?
1 Answer 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 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
Do you prescribe prophylactic steroids to patients receiving radiosurgery for AVMs?
1 Answer available
How would you determine the safety of anticoagulation in patients with evidence of cerebral microhemorrhages who present with acute stroke secondary to cardioembolism?
3 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
Would you recommend a neck soft collar after a cervical internal carotid artery dissection?
If so, what is the typical duration?
1 Answer available
How would you best evaluate and manage a patient with hemiplegic migraine and a history of ischemic stroke?
1 Answer available
Would you consider starting dual antiplatelet therapy in a patient with evidence of petechial hemorrhage post-stroke secondary to ICAD?
1 Answer available
Would you consider skipping intravenous thrombolysis in patients with tandem occlusions who qualify for endovascular thrombectomy?
1 Answer available
How do you manage patients with a prior intracerebral hemorrhage from probable cerebral amyloid angiopathy who develop new small vessel ischemic infarcts?
Would you consider using cilostazol instead of antiplatelets?
1 Answer available
Do you consider intervention vs medical therapy alone in patients with an ischemic stroke and suspected symptomatic ipsilateral carotid web with less than 50% stenosis?
1 Answer 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
When do you consider stenting in patients with recurrent stroke with ICAD?
2 Answers available
What is the preferred approach to managing non-occlusive or partially occlusive venous sinus thrombosis?
1 Answer 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
When do you consider patients with acute stroke with large vessel occlusion with very low ASPECTS scores (less than 3) for endovascular thrombectomy?
In light of meta-analysis data showing favorable outcomes in this normally excluded subset of patients (Katsanos et al., PMID 37775318).
1 Answer available
When would you consider neuro-stimulants in post-stroke patients?
Is there management guidance on when to start after stroke onset?
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
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
Should follow-up imaging for unruptured intracranial aneurysms include MRA head and MRI brain to evaluate for arterial wall enhancement?
1 Answer available
What do you advise regarding the timing and safety of major surgery in patients with moderate to severe intracranial atherosclerosis?
Does your approach differ if the stenosis is symptomatic or flow-limiting?
1 Answer 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
When is brain biopsy useful/warranted as part of the diagnostic work-up in patients with suspected primary CNS angiitis?
3 Answers available
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.
2 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?
2 Answers available
Do you screen adults in your practice with sickle cell disease for silent cerebral infarcts?
The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...
1 Answer available
Would you administer IV thrombolysis in a patient presenting with disabling stroke symptoms while on anti-amyloid therapy?
4 Answers available
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.
1 Answer available
Do you typically use NOACs or Lovenox in patients with stroke due to hypercoagulability from malignancy?
1 Answer available
Do you avoid SSRIs in patients with a history of RCVS?
2 Answers available
How often do you screen for cerebral aneurysms in patients with autosomal dominant polycystic kidney disease who do not have a family history of intracranial aneurysms or for whom the family history is unknown?
1 Answer available
When do you re-image patients with a diagnosis of venous sinus thrombosis?
2 Answers available
Should perfusion imaging be the standard of care in cases of a severe symptomatic intracranial stenosis?
If yes, is there a preference with MRI or CT technique?
5 Answers available
Is perfusion imaging reliable in determining stroke infarct vs. area at risk?
2 Answers available
How do you manage asymptomatic patients with incidental findings of the carotid web?
2 Answers available
When do you consider treating intracerebral hemorrhage associated with cerebral amyloid angiopathy as an inflammatory CAA?
How would you treat it?
1 Answer available
Would you recommend genetic polymorphic testing before the initiation of antiplatelet medication in patients with ICAD?
4 Answers available
How do you manage incidentally found venous sinus thrombosis?
5 Answers available
Would you consider dual antiplatelet therapy for stroke prevention for ICAD in patients with a history of SAH?
2 Answers available
What criteria are used to choose a specific dose of aspirin in ischemic stroke?
We have seen 81 vs 162 vs 325 mg up to 1300 mg.
3 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
What duration of dual antiplatelet therapy do you use for secondary prevention of ischemic stroke due to intracranial atherosclerotic disease?
While some have the practice of 90 days per SAMMPRIS trial, the lower rates of ischemic stroke in the medical therapy group were driven by events with...
8 Answers available
Do you start aspirin for patients with incidentally found intracranial vertebral stenosis?
3 Answers available
When do you refer patients diagnosed with Moyamoya disease to neurosurgery?
2 Answers available
How do you address incidental small cerebellar infarcts seen on MRI?
This is not an infrequent finding in outpatient neurology practice, often in the absence of any lacunar disease in the typical regions, though I usual...
3 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
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
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?
2 Answers available
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.
2 Answers available
What would be the clinical benefit of multiphase CTA over CTP?
Should MTCTA be standard for anyone with LKN>=6h?
4 Answers available
Do you usually recommend PFO closure for patients with frequent migraines with aura?
1 Answer available
When should one consider obtaining a cardiac MRI in ischemic stroke patients?
What is the utility of it? 
1 Answer available
When do you restart antiplatelet therapy in patients with hemorrhagic conversion of stroke?
2 Answers available
What adjustments do you make to a hemodialysis prescription for a patient with a recent stroke?
3 Answers available
Would you recommend anti-platelet or anticoagulation in a patient with recurrent strokes, CADASIL, and Antiphospholipid Syndrome?
1 Answer 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
Considering only cerebrovascular indications, are there circumstances in which you would use aspirin along with a DOAC in patients with atrial fibrillation and stroke?
6 Answers available
In antiphospholipid syndrome with recurrent strokes, would you consider adding antiplatelets to warfarin?
Also how would you manage this perioperatively?
7 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
How do you approach a patient with atrial fibrillation on apixaban who has a new cardioembolic stroke?
3 Answers available
In patients with Afib on anticoagulation and concurrent intracranial atherosclerotic disease, would you consider adding an anti-platelet to anticoagulation if there are recurrent events that could be related to the ICAD?
1 Answer available
In patients with embolic stroke and a PFO, how often do you go beyond venous Doppler of the lower extremities to screen for DVT (e.g. MRV or CTV abdomen and pelvis)?
Would you anticoagulate if this screening is negative pending PFO closure?
1 Answer available
Would you start anticoagulation in a patient with a history of CVA 1 year ago and high risk APL profile who was never started on anticoagulation, but is now presenting for follow up and without recurrent thrombotic events?
The patient has no known history of autoimmune disease.
4 Answers available
Is there a preference between the different high-intensity statins for high-risk stroke patients?
How does pravastatin differ in advantage from other high-intensity statins?
3 Answers available
Does the presence and location of cerebral microbleeds affect your decision for antithrombotic treatment in patients with atrial fibrillation?
Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...
3 Answers available
When can you utilize external ventricular drains (EVDs) in the management of posterior fossa strokes?
Do all malignant posterior fossa infarcts need sub-occipital craniectomy or are there a subset of cases that can be managed with EVD? 
1 Answer available
What additional testing besides LAC/APLS, factor V Leiden, prothrombin gene mutation, JAK 2 do you draw for unprovoked cerebral venous sinus thrombosis?
1 Answer available
Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?
2 Answers available
What guidance do you provide for anesthesia in patients with incidentally found carotid web?
1 Answer available
Do you recommend life long aspirin 81mg daily for non-specific T2 white matter hyper-intensities on MRI brain?
7 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
Do you consider a severe ICA stenosis (70-99% narrowing per NASCET criteria) symptomatic if a lacunar stroke attributable to small vessel disease occurs in the perforating arteries (e.g. lenticulostriate) downstream from the stenosis?
Do you offer this person a vascular intervention (i.e., CEA or stenting)?
1 Answer available
What pre-operative work-up do you follow in your institution prior to EC-IC bypass in patients with a focal intracranial stenosis and patients with MMD?
1 Answer available
Is there a role to continue aspirin in patients with myeloproliferative disorders who have never had a thrombotic event that are starting DOAC for stroke prophylaxis with newly diagnosed atrial fibrillation?
2 Answers available
How long do you wait before foley or IV placement in patients who have recieved TNK or TPA?
3 Answers available
What are current strategies to treat severe symptomatic basilar stenosis failing medical therapy?
2 Answers available
How do you define impaired distal fusion in patients with ICAD?
In what ways, if any, does the timing of perfusion imaging from onset of stroke symptoms affect its utility in informing quality of distal perfusion?
2 Answers available
Would you recommend switching to DAPT for patients on anticoagulation who develop symptoms of a TIA secondary to ICAD?
3 Answers available
How can you differentiate perforator disease vs artery-to-artery embolus as a stroke etiology?
1 Answer 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
What antithrombotic regimen do you recommend prior to and in anticipation of CEA for patients with symptomatic carotid stenosis?
2 Answers 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
How will you treat a young man with recurrent cryptogenic strokes with no identifiable cause, with MTHFR A1298C homozygous mutation and normal homocysteine level?
1 Answer 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
Is LP indicated for patients with recurrent thunderclap headaches over a 4-week period and negative head imaging for SAH?
2 Answers available
Do you recommend antiplatelet therapy for patients who have suffered stroke due to CADASIL?
3 Answers available
Would you favor restarting anticoagulation or pursuing left atrial appendage closure in a patient with hemorrhagic stroke on anticoagulation for non-valvular atrial fibrillation?
3 Answers available
What is your practice for the timing of resumption of oral anticoagulation after ICH?
Do you order any imaging beforehand? Are there other studies that you order?  
1 Answer available
What is the recommended management approach in regard to diagnostic evaluation and treatment for patients with homocystinuria and cerebral thrombosis?
Do we prophylactically place patients on anticoagulation after one episode? Besides MRI/MRV brain, are there other diagnostic imaging that should b...
1 Answer available
Are triptans contraindicated in patients with Moya Moya syndrome who have never had an ischemic stroke?
2 Answers available
Do you typically recommend platelet transfusions in patients with spontaneous ICH?
Do you have a particular cutoff?
2 Answers available
When do you recommend MRA in patients with spontaneous ICH and negative CTA?
Do you ever recommend any specific sequences on MRA?
3 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
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...
3 Answers available
Do you ever do surveillance MR imaging in patients with stable exam and history of cardioembolic stroke?
1 Answer available
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?
3 Answers available
Do you recommend genetic testing after a patient on clopidogrel has a stroke based on the results of the CHANCE-2 trial?
3 Answers available
Would you consider anticoagulation for a young patient with a recent embolic stroke and newly diagnosed global cardiac hypokinesis with ejection fraction of less than 25%?
No thrombus detected on echocardiogram and no evidence of atrial fibrillation is present.
1 Answer available
Would you recommend short-term dual antiplatelet therapy for a patient who received tPA, and is otherwise eligible for dual antiplatelet therapy per POINT or SAMMPRIS trial?
3 Answers available
What is your approach for a patient with an acute ischemic stroke caused by an aortic thrombus?
2 Answers available
How would you approach protein S deficiency found on hypercoagulability work-up in a patient with a post-operative central retinal vein occlusion?
In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...
4 Answers available
How long after starting anticoagulation would you remove an IVC filter in a patient with a DVT presenting with stroke and PFO which is now closed?
1 Answer 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
How do you decide between TCAR vs. carotid stenting for patients unstable for CEA?
2 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 does evidence of cerebral amyloid angiopathy/microbleeds affect choices for secondary stroke prevention in patients with a history of ischemic stroke and atrial fibrillation?
How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...
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
Would it be prudent to complete long term cardiac monitoring (ie. 30 day) in a patient with a new typical appearing lacunar type thalamic infarct and history of hypertension?
1 Answer available
Is antiplatelet or anticoagulant therapy preferred for the secondary prophylaxis of cryptogenic stroke in a patient with underlying malignancy?
4 Answers 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
For patients with atrial fibrillation on DOAC, when should they resume DOAC after a thalamic bleed without intraventricular bleed?
How does presence of intraventricular hemorrhage change your recommendations?
2 Answers available
When do you consider middle meningeal artery embolization in patients with recurrent subdural hemorrhages?
In what clinical scenario would you refer a patient for embolization? Are there any contraindications? 
1 Answer available
How do you determine if a patient is safe to drive after having a PCA infarct?
What is the best way to determine if patients with new PCA territory infarct can drive? Upon discharge from the hospital, do you routinely refer them ...
1 Answer available
What is your steroid-sparing agent of choice to treat GCA given the current tocilizumab shortage?
Thoughts on sarilumab vs methotrexate, or just treat with steroids alone
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 start anticoagulation for secondary prevention in patients with HFrEF and history of embolic strokes?
For a relatively young, medically compliant patient with HFrEF (EF<35%) and h/o embolic stroke, what is the consensus of starting AC for secondary ...
1 Answer available
When is the best time to consider left atrial appendage closure for secondary stroke prevention in patients with atrial fibrillation?
For example, with a Watchman device? What is the evidence behind this?
1 Answer available
When do you restart anticoagulation in patients with atrial fibrillation who just had an ischemic stroke?
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
Should patients who have had hemorrhagic strokes be restarted on oral anticoagulation?
If so, how do you decide when to restart anticoagulants?
1 Answer available
How do you determine the timing of anticoagulation for patients with large MCA strokes secondary to atrial fibrillation?
1 Answer available
Should patients with cerebral amyloid angiopathy have any statin medications discontinued?
1 Answer available
In what clinical settings is acute ICH clot removal recommended?
1 Answer available
In patients with recurrent ischemic infarcts on the same side as an internal carotid artery lesion, is intervention warranted even if there is less than 50% obstruction?
When would you consider stenting or CEA even if there is less than 50 obstruction when no other etiology has been found?
1 Answer available
How do you limit the onset of new strokes in patients with Moya-Moya syndrome?
1 Answer available


Papers discussed in this category

American journal of hematology, 2023 May 12
An integrated therapeutic approach to sickle cell disease management beyond infancy.
The New England journal of medicine, 2014 Aug 21
More blood for sickle cell anemia?
Stroke, 2020 Aug 06
Anticoagulation Type and Early Recurrence in Cardioembolic Stroke: The IAC Study.
Neurology. Clinical practice, 2018-02
Anticoagulation for atrial fibrillation after intracranial hemorrhage: A systematic review.
Stroke, 2015 May 28
Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
Stroke, 2019-02
Ischemic Stroke and Internal Carotid Artery Web.
Stroke, 2011-04
Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
Ann Neurol, 2020 Aug 05
Anticoagulation Timing in Cardioembolic Stroke and Recurrent Event Risk.
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2019-08
Treatment Approaches to Lacunar Stroke.
Stroke, 2021 Sep 14
Cilostazol for Secondary Stroke Prevention: History, Evidence, Limitations, and Possibilities.
Stroke, 2015-03
Outcome in patients previously on antithrombotic therapy in the SAMMPRIS trial: subgroup analysis.
BMJ open, 2014-12-02
Is clopidogrel better than aspirin following breakthrough strokes while on aspirin? A retrospective cohort study.
J Am Coll Cardiol,
Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial.
Neurology, 2015-09-29
Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE.
Stroke, 2017-08
Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting.
Stroke, 2021 May 24
2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association.
Lancet (London, England), 2014-01-25
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