Hospital Medicine   

Traumatic brain injury 

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

Is there any evidence supporting the use of heparin boluses?

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

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

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

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...

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

When would you consider using anticoagulation and for how long?

E.g., patients with small CNS mets without vasogenic edema or symptoms. Epidural disease without epidural spinal cord compression or asymptomatic low-...

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

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

Especially in an inpatient setting when EMG is not immediately available.

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

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

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

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

In light of TIMELESS and TRACE-III trials.

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

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

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

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

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

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

How does the 2HELPS2B scoring tool play a role in your decision-making?

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

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

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?

Many recent studies cast doubt on continuous vs repeated routine EEG.

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 ...

Fibrinogen level >200.

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

There are some data supporting the use of IV lidocaine as an abortive treatment for migraine, NDPH, and some trigeminal autonomic cephalalgias, when d...

If the patient is in burst-suppression once EEG is connected, how long do you keep patient in burst-suppression before weaning sedation?

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...

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

Or love to share personal experiences/articles?

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...

For example, a patient with 2 Hz GPDs with hepatic or uremic encephalopathy.

Does timing relative to initiation of antibiotics matter?

What modality do you prefer?

If so, for how long?

Is there any data supporting this?

Do you have a particular cutoff?

Instead of waiting for the antibody test to result, if you have a high suspicion for NMDAR encephalitis, is there a role for giving rituximab alongsid...

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

What are your thoughts on the ethics of inpatient use of sedatives in these patients to help with agitation to “protect themselves from harm and...

What effective modalities have you found for acute exacerbations of trigeminal neuralgia including in patients who present to the ED? 

What factors influence your thinking?

The most frequently taught cause of asterixis is hepatopathy and of course hepatic encephalopathy, and has other close associations (ie, uremia), I ha...

For what duration do you use therapy?

Is there any benefit to starting hyperosmolar therapy prior to the development of depressed level of consciousness or midline shift?

e.g. DITP from eptifibatide after a cardiac intervention

How do you treat refractory focal status epilepticus in an adult with history of alcoholism and traumatic bilateral subdural hematomas who is failing ...

What is the your preferred loading (and maintenance) dose for use of Perampanel in the treatment of refractory status epilepticus?

What modality do you prefer?

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...

In patients undergoing continuous EEG monitoring in the ICU, we often encounter EEG patterns that lie along the inter-ictal continuum (IIC). In such c...