Questions
Ask the room.
0votes
1ans
93
views
Differentiating Alzheimer's disease from vascular dementia — clinical, neuroimaging, and biomarker approach
A 74-year-old hypertensive male presents with a 2-year history of progressive cognitive decline. His deficits began abruptly after a lacunar infarct and have progressed in a stepwi…
0votes
1ans
90
views
CGRP antagonists vs traditional migraine prophylaxis (topiramate, propranolol, amitriptyline) — when to escalate?
A 35-year-old female with chronic migraine (> 15 headache days/month) has failed topiramate and amitriptyline due to side effects. She is now on overusing triptans. What is the cur…
0votes
1ans
103
views
Systematic approach to peripheral neuropathy workup: axonal vs demyelinating, and key treatable causes
A 58-year-old diabetic male presents with bilateral symmetric distal numbness, burning pain, and mild weakness of foot dorsiflexion. EMG/NCS shows predominantly axonal sensorimotor…
0votes
2ans
82
views
Prevention and management of cerebral vasospasm after aneurysmal subarachnoid hemorrhage
A 55-year-old woman with aneurysmal SAH (Hunt-Hess grade 3, Fisher grade 3) had successful coil embolization on day 1. On day 5, she develops new focal deficits and TCD shows eleva…
0votes
0ans
118
views
When to initiate levodopa in Parkinson's disease — early vs delayed treatment debate
A 62-year-old man with newly diagnosed Parkinson's disease presents with mild resting tremor, rigidity, and bradykinesia but is still functionally independent. He asks whether star…
0votes
0ans
121
views
Management of Guillain-Barré syndrome: IVIG vs plasmapheresis, and ICU monitoring criteria
A 30-year-old male presents with ascending weakness starting in the legs, areflexia, and mild respiratory compromise 2 weeks after a campylobacter gastroenteritis. NCS confirms AID…
0votes
1ans
93
views
Headache red flags (SNOOP4) — which patients need urgent neuroimaging?
A 42-year-old woman presents to the ED with a sudden severe headache she describes as the worst of her life, with onset during exercise. No fever, no neck stiffness initially. How …
0votes
0ans
131
views
Key differences between MS and NMOSD: clinical, imaging, and CSF findings
A 28-year-old female presents with bilateral optic neuritis and transverse myelitis extending over 3 vertebral segments. MRI spine shows a long central cord lesion at C3-C6. Serum …
4votes
1ans
98
views
Step-by-step management of refractory status epilepticus in the ICU
A 35-year-old known epileptic presents with continuous tonic-clonic seizure activity lasting > 30 minutes unresponsive to IV lorazepam 4mg and IV levetiracetam 3g. He is now intuba…
0votes
0ans
112
views
Ischemic stroke thrombolysis beyond the 4.5-hour window: who qualifies with advanced imaging?
A 67-year-old patient woke up with right-sided hemiparesis and aphasia. Time last known well is 9 hours ago. NIHSS is 12. MRI DWI shows small core infarct with large penumbra on pe…
0votes
1ans
82
views
Bacterial meningitis empirical antibiotic choice — dexamethasone timing and LP before CT dilemma?
25M presents to ED with fever 39.8°C, severe headache, neck stiffness, and photophobia for 6 hours. GCS 14 (E3V5M6). No focal neurological deficits. Petechial rash on trunk and low…
0votes
1ans
67
views
Guillain-Barré syndrome — IVIG vs plasma exchange, criteria for ICU admission and intubation?
55M presents with progressive ascending weakness over 2 weeks. Started with bilateral leg weakness, now involves upper limbs (MRC grade 3/5 all four limbs), absent deep tendon refl…
0votes
1ans
80
views
Refractory status epilepticus — benzodiazepine failure protocol, when to use propofol vs midazolam infusion?
42M admitted with refractory status epilepticus. Given lorazepam 4mg IV (2 doses), no cessation. Levetiracetam 60mg/kg loading dose given. Continuous EEG shows generalized electrog…
0votes
3ans
74
views
Chronic migraine prevention — CGRP monoclonal antibodies vs topiramate vs amitriptyline, which first-line?
34F with chronic migraine (>15 headache days/month for >3 months, >8 migraine days/month). Has failed topiramate 100mg/day (poor tolerance — cognitive side effects), amitriptyline …
0votes
1ans
69
views
Early Parkinson's disease — levodopa vs dopamine agonist as first-line therapy in young-onset PD?
46M with tremor-predominant Parkinson's disease, newly diagnosed. MDS-UPDRS Part III score 28. Tremor is predominantly right-hand, mildly affecting his work as a software engineer.…
0votes
1ans
75
views
Multiple sclerosis relapse management — high-dose IV methylprednisolone vs oral steroids, when to use?
28F with known RRMS on natalizumab, presents with a new relapse: left lower limb weakness (grade 4/5), unsteady gait, and left-sided numbness over 5 days. Brain MRI shows new T2/FL…
0votes
1ans
63
views
First unprovoked seizure in adults — when to start AED and which drug to choose?
35M with no prior seizure history presents with a witnessed generalized tonic-clonic seizure lasting 2 minutes at work. Post-ictal confusion for 20 minutes. No family history of ep…
78votes
7ans
139
views
Acute ischemic stroke workup — when to order TEE vs TTE in cryptogenic stroke?
67M, cryptogenic stroke, no AF on 48h Holter, normal carotid Doppler. Cardiology recommending TEE. What's the evidence for TEE over TTE in finding cardioembolic sources?
For peer discussion only — not a substitute for clinical judgment. Verify with authoritative sources.