Neurology&nbsp;&nbsp;&nbsp;

What is your approach to the treatment of idiopathic intracranial hypertension with transverse sinus stenosis?

Do you favor specific medications or surgical interventions?

Would you use bupropion for mood disorder or substance use in an adult patient with previous childhood seizures that resolved?

Do you counsel patients to acutely treat migraine with aura at the onset of aura or headache?

Typically, neurologists were taught to treat with triptans at the onset of headache pain. Do you still follow this teaching, or do you treat at the on...

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?

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

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

Do you try to treat the acidosis resulting from acetazolamide in patients with IIH?

Do you ever use ocular ultrasound in evaluation of papilledema?

What are the current treatment options for progressive multifocal leukoencephalopathy in patients without HIV/AIDS?

Are there any clinical trials underway to study additional therapies?

When do you consider testing with stroke gene panels in young stroke patients?

When do you consider using stimulants in patients with cognitive impairments secondary to traumatic brain injury?

How do you approach the treatment of biopsy proven ABRA (amyloid beta related angiitis)?

How do you approach anti-seizure medication management when it was started by another team for a seizure-naive patient before/after craniotomy for a tumor?

What do you recommend to reduce/treat skin reactions for those taking anti-CGRP monoclonal antibodies to treat migraine?

What is your approach to helping parents manage sleep disturbances in patients with autism spectrum disorder?

What role do anti-seizure medication levels, such as levetiracetam, serve in seizure-free patients?

Is there a role in adjusting the medication doses to levels in seizure-free patients; or is it sufficient to just monitor patients clinically?

In well-controlled epilepsy patients who suffer an unprovoked seizure with medication compliance, what would prompt you to increase their anti-seizure medication?

How do you counsel patients with epilepsy who are interested in purchasing a seizure dog?

In light of the publication of results from the EPISODE study.

Are the laws regarding prescribing C-2 medications different for mail order pharmacies?

How is it that I'm able to prescribe medications to patients (in my state) via legitimate mail order pharmacies that are located in a different state?...

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?

How do different inflammatory markers like CRP and ferritin contribute differently, if at all, to the monitoring of CART neurotoxicity?

What medications do you prioritize or avoid in Parkinson’s Disease-related psychosis and behavioral disturbance?

How do you counsel elderly patients who demonstrate mild cognitive impairment but do not meet the criteria for a neurocognitive disorder?

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 treatment do you use for stroke prevention in cervical artery dissection?

In light of the STOP-CAD study

How do you navigate C-2 refills in patients who are stable in their treatment and do not otherwise need to be clinically seen monthly?

Would you consider charging a small fee for managing C-2 prescriptions between appointments instead of requiring the patient to come monthly?

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

How do you implement antipsychotics in the management of agitation in Alzheimer’s patients?

What prompts you to procure EEG and/or imaging in patients presenting with multiple simple febrile seizures?

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 ...

What is your preferred first-line treatment for chronic fatigue in patients with long COVID-19?

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...

What is your approach to a pediatric patient presenting with a new daily persistent headache?

When do you use seizure prophylaxis in patients on clozapine?

Do you utilize thrombolytic therapy in patients with CRAO?

How do you treat patients with stroke thought to be secondary to Lambl excrescence?

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?

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

What is your diagnostic approach to patients referred for central sleep apnea on PSG but normal overnight EEG and MRI?

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 ...

What is the recommendation for women with migraine with aura who are planning to undergo IVF hormone therapy?

How do you counsel patients who experience diarrhea from mycophenolate mofetil (Cellcept)?

Do you generally recommend anti-diarrheals, dietary modifications, or consider this an unacceptable side effect and move to other therapies?

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

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...

What is your workup and treatment approach for cranial neuropathies in patients with lupus?

What is the value of sending placental pathology in neonatal patients who have suffered an in-utero arterial ischemic stroke?

Does persistent focal slowing without epileptiform discharges indicate increased seizure risk in patients without significant structural abnormalities?

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.

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.

If a patient who has previously been taking lamotrigine stops taking it for between two weeks and a month, do you have to uptitrate it all over again or do you have another way to resume it?

When do you consider discontinuation of treatment in pediatric patients who have responded well to preventive migraine medications?

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?

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.

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?

How do you utilize at-home seizure monitoring devices for your patients with epilepsy?

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...

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...

Do you avoid triptans in patients on SSRI's due to the potential risk of serotonin syndrome?

What do you do when headache appears clinically attributed to intracranial hypotension but imaging and opening pressure are normal or not obtainable?

In light of a study by Caroll et al., PMID 38820488 on epidural blood patches for patients with headaches attributed to SIH that were non-conforming t...

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?

Would you discontinue romosozumab in a patient who develops a hemorrhagic stroke while on therapy?

Do you recommend plasmapheresis for treatment of patients with osmotic demyelination?

What is your approach to secondary stroke prevention in patients with atrial fibrillation and intracranial stenosis (>70%)?

How would you approach the workup and management of a young patient with recurrent biannual non-scarring oral ulcers and new onset neurologic symptoms with associated CNS white matter lesions concerning for Behcet’s?

How do you approach use of DMARDs and/or biologics for inflammatory arthritis in patients with a history of seizure disorder on anti-epileptic medications?

Is there any concern for drug interactions of DMARDs and/or biologics with anti seizure medications?

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?

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...

Do you recommend or have any clinical experience with "migraine surgery"?

Peripheral nerve surgical decompression, i.e., "migraine surgery" is a controversial procedure mostly being advanced by plastic surgeons. The evidence...

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?

Do you obtain a MSLT or start empiric therapy with modafinil in patients with residual excessive daytime sleepiness despite optimal adherence to PAP therapy?

In patients with average of less than 5 respiratory events per hour, adequate sleep duration and hygiene confirmed on sleep log, absent cataplexy and ...

What is your approach to DVT prophylaxis in patients who require IVIG but are at increased risk for thrombotic events?

E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.

How do you approach managing nausea and GI side effects when initiating methotrexate?

How do you workup patients with neuropathy suspected to be secondary to sarcoid?

Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?

What is the optimal antithrombotic management, if at all, in patients with incidentally identified findings of multiple silent embolic appearing cerebral infarcts?

What prompts you to consider prescribing different formulations of benzodiazepines for a seizure rescue medication?

E.g., nasal, rectal, buccal.

What considerations guide your decision to perform endovascular therapy in stroke involving acute M2 or M3 occlusions?

What are your strategies for preventive migraine therapy in breastfeeding patients?

How significant are the cardiovascular side effects, such as hypertension, associated with valproate?

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?

Do you ever start a ketogenic diet in patients who present with status epilepticus admitted to the ICU?

When do you select cholinesterase inhibitors vs NMDA-antagonist medications in patients with moderate Alzheimer’s dementia?

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...

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

Would you recommend a CT venogram or MR venogram in patients with concern for venous sinus thrombosis?

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?

How do you treat extrapyramidal symptoms secondary to anti-psychotic use in patients who have not benefited from cogentin or benadryl?

How do you approach management of patients with lupus and transverse myelitis not responding to pulse dose steroids?

Do you recommend encephaloduroateriosynangiosis in pediatric patients with Moyamoya disease?

Do you recommend endovascular therapy in patients with isolated posterior cerebral artery stroke?

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?

What recommendations would you make for a patient on long-term phenytoin due to epilepsy with a newly diagnosed breast cancer requiring doxorubicin as part of her chemotherapy?

How would you counsel the patient given the drug interactions present?

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?

How do you adjust the loading and maintenance doses for Keppra when treating status epilepticus in patients with ESRD, patients on HD, or patients on CVVH?

What leads you to consider prescribing a nasal spray formulation for the treatment of acute migraine?

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.

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?

Do you typically load DAPT in patients with ICAD?

How do you approach the psychiatric symptom management of Huntington’s Disease?

What is your approach to addressing dementia-related agitation for patients living at home with family?

How do you apply the 2HELPS2B score into clinical decision making for determining duration of cEEG testing?

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?

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

What imaging do you recommend for patients with suspected CSF leak?

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.

How do you determine when to wean patients with idiopathic intracranial hypertension (IIH) off of acetazolamide?

Do you prescribe prophylactic steroids to patients receiving radiosurgery for AVMs?

What is your approach to the treatment of visual snow syndrome?

When do you consider ketamine to treat nonconvulsive status epilepticus?

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

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

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?

What treatments options may be considered in patients with POTS who also need daily diuretics to treat heart failure and are already wearing compression garments?

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

If so, what is the typical duration?

How do you manage stroke-related abulia?

Do you choose an antibiotic with CSF penetration, such as nafcillin over cefazolin, in the setting of MSSA endocarditis with septic emboli to the brain (assuming no concomitant meningitis or brain abscess)?

How would you best evaluate and manage a patient with hemiplegic migraine and a history of ischemic stroke?

How do you utilize cytokine panels in your clinical practice?

Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...

Would you consider starting dual antiplatelet therapy in a patient with evidence of petechial hemorrhage post-stroke secondary to ICAD?

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?

Would you consider skipping intravenous thrombolysis in patients with tandem occlusions who qualify for endovascular thrombectomy?

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?

How do you treat persistent headache after RCVS?

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?

Do you warn patients about suicidal ideation when starting anti-seizure medications?

Do you continue to use Botox to treat chronic migraine in a patient who becomes pregnant?

I found a study in which 32 patients continued on Botox for the treatment of chronic migraine. Only one had a miscarriage at 9 weeks and the rest seem...

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 stenting in patients with recurrent stroke with ICAD?

What is the preferred approach to managing non-occlusive or partially occlusive venous sinus thrombosis?

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?

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).

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?

When do you consider stopping anti-seizure medications in seizure-free pediatric epilepsy patients?

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

How often is a contrast-enhanced brain MRI truly normal in the setting of spontaneous intracranial hypotension?

I am aware that the radiological signs can be subtle or overlooked, or confused with a Chiari malformation, hence, I will typically review images with...

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?

Should follow-up imaging for unruptured intracranial aneurysms include MRA head and MRI brain to evaluate for arterial wall enhancement?

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?

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

When is brain biopsy useful/warranted as part of the diagnostic work-up in patients with suspected primary CNS angiitis?

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.

What abortive and preventative treatments have you found to be helpful for a vestibular migraine?

If a patient progresses from discrete episodes (hours long) of mild vertigo with rare headaches, but associated migrainous features (photophobia and n...

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?

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 ...

How do you manage seemingly treatment-resistant chronic migraine?

For example, a patient who is already on botulinum toxin injections, CGRP inhibitors, as well as an SSRI. Are there any new treatment modalities avail...

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

Would you hold CGRP (calcitonin gene-related peptide) monoclonal antibodies such as Eptinezumab-jjmr (Vyepti) before, during, or after lung SBRT?

If so, how long would you hold? This medication is given for migraines as q3 month infusions and some data suggest that CGRP plays a role in immune-mo...

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.

How do you manage patients with ice-pick headaches?

Do you typically use NOACs or Lovenox in patients with stroke due to hypercoagulability from malignancy?

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),...

Do you avoid SSRIs in patients with a history of RCVS?

How do you approach driving clearance when someone has an RNS that is showing seizure activity, but neither the patient nor the patient's family is reporting seizures?

Do you repeat a lumbar puncture in a patient living with HIV diagnosed with and treated for neurosyphilis and if so, when?

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

How long do you wait for a patient to be seizure-free before you clear them with regard to operating heavy machinery (i.e., for work)?

How will your approach to screening and diagnosis of early dementia change given newly available therapies for early Alzheimer's disease?

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?

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...

When do you re-image patients with a diagnosis of venous sinus thrombosis?

How do you counsel patients on migraine "triggers"?

What type of visual disturbance qualifies as a visual aura?

Visual aura is commonly described as a scintillating scotoma. In practice, there is a much wider spectrum of visual symptoms in the migraine populatio...

Are CGRP antagonists effective at aborting intractable headaches in hospitalized patients when traditional “migraine cocktails” have failed?

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?

What are the recommendations for considering deep brain stimulation in a patient with tremors and dementia or mild cognitive impairment?

Does the approach differ if the tremor stems from essential tremor or Parkinson's disease?

Is perfusion imaging reliable in determining stroke infarct vs. area at risk?

How do you manage asymptomatic patients with incidental findings of the carotid web?

Do you typically screen every patient with headaches after the age of 60 with ESR?

Do you consider stopping zonisamide in a female patient with epilepsy who becomes pregnant?

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 do you taper phenobarbital in a patient with epilepsy?

How do you decide the length of a routine EEG?

I.e., 20 minutes vs 30 minutes vs 1 hour.

When do you consider treating intracerebral hemorrhage associated with cerebral amyloid angiopathy as an inflammatory CAA?

How would you treat it?

What outpatient therapies do you recommend for continuous or severe pain from migraine that is refractory to acute therapies?

Short-term glucocorticoids are often prescribed as "bridge" therapy to avoid ER visits. What else should we consider?

Would you consider DHE for patients with status migrainous with elevated blood pressure at the time of presentation?

Would you recommend genetic polymorphic testing before the initiation of antiplatelet medication in patients with ICAD?

When do you consider ambulatory EEG as a reasonable alternative to inpatient video EEG?

Do you utilize post-vaccination IgG titers to detect common variable immunodeficiency in patients who are about to start or are actively on B cell depleting therapy?

Would you use sumatriptan in a patient with a history of cerebral aneurysm rupture?

Is there a role for routine EEG in the diagnostic evaluation of critically ill comatose patients or should these patients always receive long-term continuous video EEG monitoring?

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

How do you manage incidentally found venous sinus thrombosis?

Would you consider dual antiplatelet therapy for stroke prevention for ICAD in patients with a history of SAH?

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.

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.

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 would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?

Do you use vitamin B6 to help with Keppra irritability?

How do you manage patients with chronic migraine as well as medication overuse headaches?

In patients with chronic migraine and possible medication overuse headaches due to chronic narcotic use, what’s your strategy for those patients...

What is the normal range of spinal tap opening pressure?

Are there variations with different patient populations?

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

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

How would you approach additional workup and management of a patient with active Crohn’s disease, who has multiple lung and brain nodules, with lung pathology demonstrating necrotizing granulomatous inflammation and brain biopsy with granulomatous inflammation and medium-large vessel vasculitis?

The patient is on mesalamine for Crohn’s and CellCept and HCQ for skin manifestations (currently on hold during workup). The infectious workup i...

Do you start aspirin for patients with incidentally found intracranial vertebral stenosis?

When do you refer patients diagnosed with Moyamoya disease to neurosurgery?

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...

In patients with suspected RCVS, is there a role for preventative CCB if headache has resolved/now asymptomatic?

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

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.

Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?

In what clinical situation would you consider using benzodiazepines in patients with dementia?

What are the factors that you would consider for the use of ESA in patients with anemia of CKD with a history of stroke or TIA?

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?

Do you start an anti-seizure medication in a patient with a first unprovoked nocturnal seizure with a normal exam, imaging, and EEG; or wait until the second seizure?

11 Answers available

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.

When do you recommend neuropsychiatric testing in patients with post-concussive syndrome?

What would be the clinical benefit of multiphase CTA over CTP?

Should MTCTA be standard for anyone with LKN>=6h?

Do you routinely obtain baseline vascular imaging (CTA, MRA, PET) in patients with suspected GCA, but negative temporal artery biopsy?

Per 2021 GCA Vasculitis Guidelines: low evidence, but conditional recommendation for CTA neck, chest, abd/pelvis. Is anybody following this or do you ...

When do you consider genetic testing in patients with concern for hemiplegic migraine?

How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?

Would you continue KEYNOTE-522 neoadjuvant therapy? The patient has a PMH of sarcoidosis with no stroke risk factors. No residual deficits.

Do you usually recommend PFO closure for patients with frequent migraines with aura?

How do you treat patients with hemiplegic migraine?

When do you consider use of ketamine in patients with migraine with aura?

Do you avoid triptans in patients with migraine with motor aura?

How do you counsel patients interested in estrogen containing oral contraceptives who have migraine with aura?

When should one consider obtaining a cardiac MRI in ischemic stroke patients?

What is the utility of it?

How do you approach the management of EBV Meningoencephalitis (CSF pleocytosis and CSF PCR positive for EBV)?

What pharmacotherapeutic strategy do you use in catamenial epilepsy to further reduce risk of breakthrough seizures around the time of menses?

When do you restart antiplatelet therapy in patients with hemorrhagic conversion of stroke?

Do you typically consider Botox for patients with TMJ?

Would you stop belimumab in a patient with SLE starting ravulizumab (C5 inhibitor) for myasthenia gravis due to concern for additive immunosuppression?

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

Would you recommend anti-platelet or anticoagulation in a patient with recurrent strokes, CADASIL, and Antiphospholipid Syndrome?

How do you incorporate cell-phone videos when diagnosing seizures vs seizure-like episodes?

See Benbadis, AAN Commentary February 2023; 13 (1).

How do you diagnose and manage patients with hypnagogic shooting headache?

What are the diagnosis and treatment for hypnagogic shooting headache?

Do you think repeated routine EEG is sufficient for cardiac arrest patients or should we be always using continuous EEG?

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

How frequently do you monitor EKGs for patients newly initiated on lacosimide?

Is there practical utility from obtaining CSF autoantibodies in patients with suspected neuropsychiatric systemic lupus erythematosus?

At what point is it warranted to send an autoimmune epilepsy panel in patients?

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

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 ...

What is the recommended approach for extracranial bleeding after tPA?

Fibrinogen level >200.

Considering only cerebrovascular indications, are there circumstances in which you would use aspirin along with a DOAC in patients with atrial fibrillation and stroke?

In antiphospholipid syndrome with recurrent strokes, would you consider adding antiplatelets to warfarin?

Also how would you manage this perioperatively?

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...

Would testing for ATTR cardiac amyloidosis be considered in an older patient with bilateral carpal tunnel surgeries and multiple spinal stenosis surgeries, but no obvious cardiac symptoms?

What is your workup for CSF studies when evaluating for possible CNS Lupus?

In addition, what formula do you use to calculate the IgG index?

In patients with confirmed medically refractory bitemporal epilepsy, how do you decide on DBS vs RNS for treatment?

Is intracranial hemorrhage a contraindication for valproic acid?

Which IV medications do you offer for outpatient headache infusions?

If a patient is has GERD or avoids NSAIDs, do you avoid Ketorolac IV?

Do you discourage patients from skydiving/roller coasters with a Chiari malformation?

Do you ever utilize lacosimide in patients with atrial fibrillation?

How do you manage patients with post spinal tap headaches?

Are there any diagnostic tests or imaging that you recommend?

How do you approach a patient with atrial fibrillation on apixaban who has a new cardioembolic stroke?

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?

When should headache treatment be escalated to inpatient IV lidocaine?

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

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?

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.

What work-up do you recommend in patients with early-onset dementia?

Which genetic/other testing should be considered in an early-onset dementia work-up?

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?

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...

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?

How do you sequence pharmacologic treatments for primary insomnia?

How do you evaluate patients with suspected pseudo-dementia?

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

How do you approach the management of interictal discharge burden in patients with generalized epilepsy syndromes (i.e. genetic)?

Is there a difference in treatment of status epilepticus from alcohol withdrawal vs other causes?

How do you diagnose and treat patients with cervicogenic headache?

Is it possible to develop worsening motor features of Parkinson's disease (PD) when using clozapine (for treatment of PD psychosis) above a certain dose?

If so, what is the recommended maximum dose of clozapine for PD patients?

What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?

Are there any instances where you would prefer a biosimilar rather than the reference product?

What additional testing besides LAC/APLS, factor V Leiden, prothrombin gene mutation, JAK 2 do you draw for unprovoked cerebral venous sinus thrombosis?

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?

Would you recommend PFO closure in patients >60 years old with presumed paradoxical embolism as their mechanism of stroke?

What guidance do you provide for anesthesia in patients with incidentally found carotid web?

How do you target therapy before the EEG is connected in a patient who comes to the ED in super refractory generalized convulsive status epilepticus once the convulsions resolve?

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

Do you recommend life long aspirin 81mg daily for non-specific T2 white matter hyper-intensities on MRI brain?

In a patient on ASMs in the EMU that’s diagnosed with a non-epileptic event (i.e. functional seizures), and has a normal EEG, how do you approach coming off meds?

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

How would you approach grade 2 neurologic toxicity in a patient on daratumumab, dexamethasone, and lenalidomide for relapsed multiple myeloma?

Regimen currently 25 mg lenalidomide D1-21 of D28 day cycles, Daratumumab 16 mg/kg every 2 weeks.

When patients develop headaches from luspatercept, do they tend to improve over time?

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...

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...

How do you wean patients off cenobamate in the EMU and how long can these patients be off of it before having to restart the two month uptitration?

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)?

How do you approach treatment of myoclonic status epilepticus from anoxic brain injury?

Or love to share personal experiences/articles?

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?

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?

What preventive medications do you recommend for patients with cluster headaches?

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

What are current strategies to treat severe symptomatic basilar stenosis failing medical therapy?

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?

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...

Would you recommend switching to DAPT for patients on anticoagulation who develop symptoms of a TIA secondary to ICAD?

When do you recommend treating stimulus-induced generalized periodic discharges (GPDs)?

How can you differentiate perforator disease vs artery-to-artery embolus as a stroke etiology?

How do you manage a patient with progressive cerebellar ataxia and positive cardiolipin antibodies?

Do you wait 12 weeks for confirmation to begin treatment if patient is declining?

What dose do you provide of folic acid in pregnant patients with epilepsy?

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

What antithrombotic regimen do you recommend prior to and in anticipation of CEA for patients with symptomatic carotid stenosis?

Do you typically see peripheral neuropathy in patients with castleman syndrome?

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

What is your approach to initiating and titrating midodrine for both inpatient and ambulatory settings?

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

In patients chronically treated for Wilson's disease with trientine hydrochloride (Syprine®), would you expect development of neurologic symptoms?

How do you counsel patients on driving who have PNEA?

How will you treat a young man with recurrent cryptogenic strokes with no identifiable cause, with MTHFR A1298C homozygous mutation and normal homocysteine level?

Do you discontinue or adjust azathioprine when a patient develops elevated MCV after starting it?

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

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?

How would you approach the treatment of erosive inflammatory arthritis (RA or SpA) in a patient with multiple sclerosis on ocrelizumab who has failed csDMARD therapy?

When do you consider cenobamate for focal epilepsy?

How do you recommend titration?

How do you approach ictal-interictal continuum in patients with presumed toxic/metabolic etiology?

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

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

When are steroids indicated in the treatment of strep pneumo meningitis?

Does timing relative to initiation of antibiotics matter?

In what clinical situations do you treat triphasic waves on EEG?

What are some high-yield instances where triphasic waves on electroencephalogram (EEG) are more than just harmless markers of gross toxic-metabolic en...

Is LP indicated for patients with recurrent thunderclap headaches over a 4-week period and negative head imaging for SAH?

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

What modality do you prefer?

How do you approach the management of patients on lamotrigine who develop a minor rash?

Should one restart lamotrigine or look for an alternative? If no other alternative available, is slow titration vs regular titration preferred?

Do you recommend pre-emptive anti-epileptic treatment for patients with spontaneous ICH?

If so, for how long?

Do you recommend antiplatelet therapy for patients who have suffered stroke due to CADASIL?

Would you favor restarting anticoagulation or pursuing left atrial appendage closure in a patient with hemorrhagic stroke on anticoagulation for non-valvular atrial fibrillation?

Is IL-6 inhibition an option in patients who are going to be rechallenged with checkpoint inhibitors after previously developing ICI-mediated temporal arteritis?

Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?

How do you approach the diagnosis and treatment of recurrent neurosyphilis in a previously treated patient?

Are VDRL titers useful?

Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

What AEDs prevent spikes and sharp waves?

What are the best treatment options for persistent post-traumatic headaches when first line agents like TCAs have failed?

What medication do you consider in patients who cannot take indomethacin or triptans with a diagnosis of Hemicrania Continua?

Is there data for CGRP inhibitors?

Other than B12 repletion, is there any further treatment or work-up indicated in pernicious anemia with positive parietal cell antibodies?

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?

What is your preferred approach to a pregnant patient in status migrainosus refractory to first line treatments?

What is your preferred approach to a pregnant patient who is in status migrainosus that is refractory to first line treatments?

What symptomatic management do you recommend in patients with post LP headaches?

When do you consider a blood patch?

How do you approach treating patients with trigeminal trophic syndrome?

Under what circumstances would you recommend using the 2HELPS2B score to decide whether or not to pursue long-term cEEG?

While it is an excellent score for objectively assessing concerning EEG features, there are pathologies where it can be argued that long-term monitori...

What is your preferred antiepileptic medication for a patient with treatment refractory epilepsy who also has alcohol use disorder?

What is the most effective treatment for a patient with persistent post-stroke headache?

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...

When do you use levocarnitine in patients on Depakote therapy for seizures?

How do you manage anti-seizure medications at follow-up in patients who had acute symptomatic seizures due to PRES?

With studies showing rare risk of developing epilepsy after PRES do you just taper medications over the following weeks-months? Any need for outpatien...

How do you approach the initiation and/or continuation of antiseizure medication in a patient who has experienced one lifetime seizure with a normal EEG and MRI with a comorbid health condition that is associated with an increased risk of epilepsy?

(e.g. Alzheimer's disease)?

What interventions have you found most effective for reducing ED utilization in patients with PNES?

Are triptans contraindicated in patients with Moya Moya syndrome who have never had an ischemic stroke?

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

Do you have a particular cutoff?

How long after starting an antiepileptic drug do you check levels?

When do you recommend MRA in patients with spontaneous ICH and negative CTA?

Do you ever recommend any specific sequences on MRA?

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

How would you manage a patient with secondary progressive multiple sclerosis manifesting with increased neuropsychiatric manifestations (ex. psychosis) with no recent changes on brain MRI?

At what point do you refer patients with medication refractory epilepsy for surgical evaluation?

How do you tailor seizure medications in patients who become pregnant or are family planning?

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 the preferred management plan for patients diagnosed with a concussion in the acute setting?

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?

If you have a patient with isolated CN VII palsy (Bell's Palsy), and straightforward symptoms with no red flags (such as concern for carcinomatous meningitis), do you routinely get an MRI brain or do you just make a clinical diagnosis?

What is your first line treatment for a patient with epilepsy who is homeless and has a history of poor adherence?

How frequently do you check AED levels in patients with stable epilepsy?

Which triptans do you use in stroke induced migraines?

Which triptans are safer in stroke induced migraines?

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...

Do you ever do surveillance MR imaging in patients with stable exam and history of cardioembolic stroke?

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?

How do you manage tinnitus in patients with intracranial hypotension?

What is the etiology/pathology for tinnitus in Intracranial hypotension? How often is this symptom encountered in patients with intracranial hypotensi...

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.

Do you maintain an age cutoff for the use of triptans in healthy older patients without cardiovascular risk factors?

Do you perform routine screening for coronary artery disease in aging patients already taking these therapies?

When do you pursue MR imaging in patients who present for migraine evaluation?

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?

Do you always initiate hypercoagulable work up in a patient with recurrent stroke?

If so, what would you consider ordering?

Are there certain sedatives or anti-epileptic meds to avoid in patients with IDD?

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...

How would you approach the treatment of checkpoint-inhibitor-mediated temporal arteritis?

Is there role for IVIG? Would you alter the dose or time course of steroid therapy?

What holistic treatments do you recommend for patients with migraine without aura?

Which holistic treatments for migraine without aura do you recommend for patients who are refractory to standard treatments?

How do you counsel patients on anti-seizure medication necessity (or lack thereof) in the setting of PNES without comorbid epilepsy?

Occasionally, patients referred for dedicated epilepsy management for "medication refractory epilepsy" are found to have purely non-epileptic spells. ...

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

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...

What monitoring do you routinely perform on lifelong EDS for epilepsy syndromes?

For patients with generalized tonic-clonic seizures lasting > 2 minutes without IV access, what alternative medications can be used?

How does the FDA safety warning on the cardiac effects of lamotrigine, based on in vitro data, inform your clinical practice?

This question is intended to include consideration of cardiac diagnostic screening, as well as initiation & maintenance of lamotrigine, in epileps...

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

How do you manage acute exacerbations of trigeminal neuralgia?

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

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?

How do you taper off Clonazepam in women with epilepsy who are family planning?

How can one safely taper off and stop clonazepam in a woman of reproductive age with epilepsy who is taking it chronically for epilepsy and is plannin...

In what conditions can you see roving eye movements?

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?

How do you decide between TCAR vs. carotid stenting for patients unstable for CEA?

Can giant cell arteritis present with a partial cranial neuropathy?

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

What is your approach to the treatment of PML-IRIS in patients with HIV who have progressed to AIDS?

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...

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

What factors influence your thinking?

How do you treat behavioral disturbances in patients with dementia with Lewy bodies?

How do you treat dangerous behavioral disturbances (aggression, nighttime wandering) in patients with dementia with Lewy bodies (DLB)?

Do you use pimavanserin to treat psychotic symptoms in Lewy body dementia?

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?

How do you approach the management of a large vessel stroke if you anticipate the development of malignant cerebral edema?

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

Is unilateral intracranial EEG monitoring ever appropriate in the pre-surgical workup for presumed non-lesional epilepsy?

The thought being, if no clearly defined lesion exists on available neuroimaging, how do we balance the benefits, risks, and uncertainty in choosing w...

Is vaginal delivery safe in patients diagnosed with pseudotumor cerebri (IIH)?

In patients diagnosed with pseudotumor cerebri, is vaginal delivery safe? How do you manage this condition during the pregnancy?

How do you treat lupus-associated small fiber neuropathy?

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?

Is antiplatelet or anticoagulant therapy preferred for the secondary prophylaxis of cryptogenic stroke in a patient with underlying malignancy?

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

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

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

What is the negative predictive value of a completely unremarkable EMU admission?

By completely unremarkable, I mean zero clinical events AND zero interictal abnormalities despite full withdrawal of medications. Assume, for the sake...

How do you approach the workup and management of patients with suspected functional neurologic disorders?

What testing do you typically proceed with?

How do you treat refractory focal status epilepticus in patients with traumatic bilateral subdural hematomas?

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

Do you always perform temporal artery biopsy in patients with positive inflammatory markers and high clinical suspicion of GCA?

Is either ESR or CRP more sensitive or specific for the diagnosis of GCA?

Additionally, what is the current role for temporal artery ultrasound in workup for GCA?

How do you prescribe Perampanel for use in patients with refractory status epilepticus?

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

How do you treat post-IVIG headache that is not responsive to Tylenol or NSAIDs?

Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...

What is the utility in repeating a temporal ultrasound (US) in a previously US diagnosed positive GCA patient who has received treatment and is presenting with recurrent GCA symptoms?

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?

At what intervals do you obtain DEXA scans for patients on antiseizure medications?

The question is broad and is meant to include patients who have healthy BMD, osteopenia, and osteoporosis, as well as exposure to first generation AED...

When is follow-up imaging warranted in patients with anoxic brain injury?

What modality do you prefer?

What abortive migraine treatment is preferred in pregnant patients?

What workup do you recommend for patients with stabbing headaches?

How do you approach treatment?

What DHE migraine protocol works best for acute treatment both in terms of dosage and timeframe?

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?

When would you consider checking JC virus prior to initiating biologic therapy?

Do you recommend work up for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?

Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...

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 ...

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

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...

What is your approach to checking serum vWF antigen levels in adult patients with CNS vasculitis for monitoring disease activity?

Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)

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 ...

What treatments would you recommend in patients with adult-onset Rasmussen’s encephalitis after the patient is on two or more AEDs?

Is there an AED of choice?

Do you routinely recommend a sleep study in patients with clinical history of REM-sleep behavior disorder?

Does this add any value?

In what situation do you use nerve blocks in patients with headache?

For patients with post-stroke headaches, what treatment do you typically recommend?

In patients in the ICU who are on the inter-ictal continuum, how do you decide whether or not to treat for potential non-convulsive status epilepticus?

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...

Would you recommend a CGRP inhibitor for migraine prevention in pregnant patients?

Are there contra-indications while breast-feeding?

At what point could starting AEDs be considered for patients with recurrent simple febrile seizures?

What steps should be taken to wean them off?

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?

How do you approach the management of poorly controlled migraines during pregnancy?

When do you restart anticoagulation in patients with atrial fibrillation who just had an ischemic stroke?

What is your approach for treating mononeuritis multiplex in patients with ANCA vasculitis?

Specifically, do you reach for Rituximab or cyclophosphamide?

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

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

When do you recommend electrical stimulation (Cefaly device) in patients with chronic migraine, if at all?

Should patients who have had hemorrhagic strokes be restarted on oral anticoagulation?

If so, how do you decide when to restart anticoagulants?

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

Should patients with cerebral amyloid angiopathy have any statin medications discontinued?

In what clinical settings is acute ICH clot removal recommended?

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?

How do you limit the onset of new strokes in patients with Moya-Moya syndrome?

Are there features of a nerve biopsy that help distinguish late nerve damage from vasculitis versus from a demyelinating disease?

Do you treat HIV/AIDS-associated CNS vasculitis with antiretrovirals alone or in combination with steroids?

How do you monitor response to treatment in patients with mononeuritis multiplex secondary to vasculitis?

Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...