Neurology

Vascular Neurology   

Questions discussed in this category



In light of data from Chang et al in J Neurol Aug 2024 showing that biomarkers such as LDH and troponin were associated with adverse clinical outcomes...

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 ...

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...

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

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...

Would you recommend left atrial appendage occlusion with or without continuing anticoagulation? In light of Maarse et al., JAMA Neurology 2024.

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...

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

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

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...

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...

If yes, if the assay shows they are a non-responder, do you switch to ticagrelor?

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

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

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

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

The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...

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.

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...

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

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

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...

How does pravastatin differ in advantage from other high-intensity statins?

Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...

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

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

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?

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

Do we prophylactically place patients on anticoagulation after one episode? Besides MRI/MRV brain, are there other diagnostic imaging that should b...

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

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

In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...

How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...

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

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 ...

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 ...


Papers discussed in this category


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Arthritis Rheum,

American heart journal, 2010-07

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Stroke, 2020 Apr 21

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Stroke, 2014-07

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Circulation, 2023 Aug 27

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

JAMA, 2023 Jun 27

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Stroke, 1997 Nov

The New England journal of medicine, 2023 Jan 04

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JAMA neurology, 2018-12-01

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

Circulation, 2021 Apr 08

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JAMA, 2014 Jul 16

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JAMA neurology, 2022 Jan 01

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The Lancet. Neurology, 2021 Mar 17

The New England journal of medicine, 2024 May 16

JAMA, 2024 Mar 05

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Stroke, 2024 Feb 01

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The New England journal of medicine, 2006 Aug 10

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