Neurohospitalist   

Questions discussed in this category



In light of meta-analysis data showing favorable outcomes in this normally excluded subset of patients (Katsanos et al., PMID 37775318).

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

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...

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

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

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?

Are there variations with different patient populations?

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?

MRI Orbits with possible mild enhancement of unilateral CN3; Brain MRI chronic microvascular disease, mild atrophy. 

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 ...

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

Are there any diagnostic tests or imaging that you recommend?

Do all malignant posterior fossa infarcts need sub-occipital craniectomy or are there a subset of cases that can be managed with EVD? 

In a patient who is already on a standing regimen of baclofen, tizanidine, trihexyphenidyl, clonidine, and diazepam and who is taking additional diaze...

This applies to using EVD either in addition to or instead of a large volume lumbar puncture.

Anecdotally, the diagnostic yield in these patients seems quite low, yet autoimmune encephalitis is often invoked in such patients, particularly in th...

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 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.

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

Do you order any imaging beforehand? Are there other studies that you order?  

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

Although probably more familiar to ophthalmologists, orbital apex syndrome refers to the consequence of any kind of swelling or mass effect within the...

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

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

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

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

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

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

Do you biopsy immediately, stop treatment, biopsy at a later time, or depend solely on the data you already have?

In what clinical scenario would you refer a patient for embolization? Are there any contraindications? 

How long do you wait (from onset of symptoms) to do a EMG/NCS in a patient with GBS?

Is there is a particular pattern of extraocular motility restriction in Miller Fisher syndrome? 

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...

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 ...

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...


Papers discussed in this category


Stroke, 2020 Aug 06

Neurology. Clinical practice, 2018-02

Stroke, 2015 May 28

Lancet Neurol, 2022 09

Stroke, 2022 May 17

Stroke, 2019-02

Stroke, 2011-04

Ann Neurol, 2020 Aug 05

Neurotherapeutics,

Lancet Neurol, 2017 Sep

Archives of neurology, 2009-06

Muscle & nerve, 2013-04

Muscle & nerve, 2016-08

Muscle & nerve, 2017-07

Annals of neurology, 2017-07

J Neurol, 2021 Jul 17

Headache, 1990-05

Neurology, 1986-07

Headache, 1997-03

J Pain Res, 2020 Apr 30

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The New England journal of medicine, 2018-10-04

The New England journal of medicine, 2019-05-16

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Arthritis Rheumatol, 2021 Jul 08

Ann Rheum Dis, 2019 Jul 03

Continuum (Minneap Minn),

Obstet Gynecol Surv,

Mayo Clin Proc,

J Clin Neurophysiol,

Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 2016-02

J Clin Neurophysiol,

Neurology, 2019 Jan 11

The Lancet. Neurology, 2016-05

Postgrad Med J,

Anesth Essays Res,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1993-03

Neurosurgery,

Ann Rheum Dis, 2021 Jul 02

Tremor and other hyperkinetic movements (New York, N.Y.), 2014

J Rehabil Med Clin Commun, 2021 Feb 24

Stroke, 2021 May 24

eNeurologicalSci, 2017 Aug 02

Neurol Clin Pract,

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Lancet,

Lancet Neurol, 2021 Mar 17

Ann Neurol,

Eur J Neurol, 2017 Aug 20

Cancer, 2011 Feb 01

JAMA,

Stroke, 2016 Dec 20

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J Thromb Haemost, 2010 Apr 08

Lancet Neurol, 2021 Sep 03

The New England journal of medicine, 2018-07-19

N Engl J Med, 2013 Jun 26

Headache, 2020 Sep 27

Cephalalgia, 2022 Apr 25

Cephalalgia, 2022 Apr 26

Archives of ophthalmology (Chicago, Ill. : 1960), 1988-08

Circulation, 2009-03-31

Cerebrovascular diseases (Basel, Switzerland), 2014

JAMA Neurol,

Neurology, 2011-01-18

The Lancet. Neurology, 2016-04

Lancet, 2016 May 10

J Neurol Neurosurg Psychiatry, 2016 May 13

J Am Heart Assoc, 2021 Feb 15

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Cochrane Database Syst Rev, 2015 Sep 12

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The New England journal of medicine, 2018-02-15

N Engl J Med, 2020 Mar 29

N Engl J Med, 2003 Jul 10

Stroke, 2013-10

Stroke, 2016-01

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2019-08

Journal of the neurological sciences, 2019-08-15

JAMA, 2018-07-10

European stroke journal, 2017 Nov 29

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JAMA neurology, 2020 Aug 01

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The Lancet. Neurology, 2007 Mar

Neurology, 2015-09-29

N Engl J Med,

Resuscitation, 2018 Aug 25

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General thoracic and cardiovascular surgery, 2022 Jul 25

Interactive cardiovascular and thoracic surgery, 2007 Jan 04

Neurology, 2020 Sep 01

Lancet (London, England), 2018-08-04

JAMA, 2023 Jun 27

Lancet (London, England), 2014-11-29

Stroke, 1997 Nov

The New England journal of medicine, 2023 Jan 04

The journal of prevention of Alzheimer's disease, 2023

Neurocritical care, 2005

Clinical neurophysiology practice, 2022 May 16

Radiology, 2016-06

Neurologia medico-chirurgica, 2021 Dec 24

The New England journal of medicine, 2023 Feb 10

The New England journal of medicine, 2023 Feb 10

Journal of neuroimaging : official journal of the American Society of Neuroimaging, 2007-01

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2010

Circulation, 2021 Apr 08

Journal of the American College of Cardiology, 2011 May 03

JAMA, 2014 Jul 16

JAMA surgery, 2022 Aug 10

JAMA neurology, 2021 Mar 01

JAMA neurology, 2022 Jan 01

Lancet (London, England), 2023 Mar 29

Journal of neuroimaging : official journal of the American Society of Neuroimaging, 2020 Feb 10

Lancet (London, England), 2014-01-25

Lancet Neurol, 2019 May 23

The Lancet. Neurology, 2021 Mar 17