Category Archives: Patient Care

Involve the Palliative Care Team Early

Here’s a sad story about a family’s struggle with their young son’s fatal ordeal with New Onset Refractory Status Epilepticus (NORSE). NORSE is basically super-refractory status absent an obvious precipitating injury such as encephalitis. The main theme in this account is … Continue reading

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The Queen of Specialties . . .

. . . is what neurology is sometimes called. NPR just did a nice little segment wherein they followed Dr. Allan Ropper making rounds at Mass. General, demonstrating that clinical acumen remains fundamental to our specialty. Nothing really new here for … Continue reading

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Mechanical Heart Valves: Dual Antithrombotic Therapy?

The question came up at stroke conference today, and here’s a link to the American College of Chest Physicians guideline that addresses the issue. On the basis of a meta-analysis of relatively low-quality research reports, they recommend, for patients at low … Continue reading

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Medicine by The Numbers

Aaron F Struck, MD 10 September 2013 University of Wisconsin Department of Neurology  My father, the accountant, once told me, “I don’t get this obsession with graphs in the boardroom—just give me the numbers.” This typifies one way of understanding … Continue reading

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Doing More, or Gizmo Idolatry

Writes a longtime friend and colleague (some details changed for privacy): 43yo man with right MCA stroke, found to have right ICA extracranial dissection with possible pseudoaneurysm right below petrous portion. Given the stroke, I put him on Coumadin and … Continue reading

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The Neurological Method

Today’s morning report was a very challenging and interesting case of headache with unusual MRI findings. I thought that, with some redirection, we had a very robust discussion that was well worth the hour spent. It was a great example … Continue reading

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A Bayesian Approach to Ruling out Neurological Disease

As most readers of this blog are aware, I’m an amateur student of the psychology of decision-making (in fact, there a tag for this over on the right). Having just finished Nate Silver’s excellent book, The Signal and the Noise, I’ve … Continue reading

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Neonatal and Pediatric Stroke

As promised, here’s some follow-up from Dr. Edelman’s excellent talk today. First, here is a nice review of perinatal stroke. They emphasize the importance of the newborn’s immature coagulation system and his recent attachment to the placenta, which has unique … Continue reading

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Generalized Periodic Discharges

It seems that stroke isn’t the only neurological subspecialty developing technologies that we don’t exactly know how to apply in practice. In this week’s Green Journal, Foreman, et al. published a very interesting study of critically ill patients undergoing continuous EEG. … Continue reading

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Dabigatran II

Another question that was raised at grand rounds was why the FDA approved the 150 mg dose but not the 110 mg dose. Representatives of the FDA addressed that very question in a NEJM article last year. They noted that … Continue reading

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