As a trainee in neurology, I am always on the lookout for hiccups in my daily patient encounters.
These can be the clinical dilemmas that made me think twice.
These can be the expert opinions that have gone unquestioned.
These can be the exclusion criteria that have stemmed from fear or ignorant caution.
These may not be the large, paradigm-changing, philosophical questions published in the New England Journal of Medicine.
But these certainly are my itches that I would like to scratch.
Who knows? Perhaps it’ll scratch your itch too.
I’m pondering:
- What is the optimal blood pressure control post-endovascular thrombectomy for acute ischemic stroke with large vessel occlusion?
- What is the impact of aiming for clot clearance in one go during endovascular thrombectomy for acute ischemic stroke with large vessel occlusion?
- Is endovascular thrombectomy beneficial for acute ischemic stroke due to medium-sized vessel occlusion (e.g. distal M2, M3)?
- Are patients on anticoagulants really at a higher risk of ICH if they were given thrombolysis for acute ischemic stroke? If so, how high is the risk? Is the risk outweighed by the benefit of reperfusion? Are all patients on anticoagulants equal?
- What is the plan B for patients who have failed oral anticoagulants? Switching oral anticoagulants? Discussing the option of LAAO?
- How does one translate a clinical disease into a biological definition?
- The greatest diagnostic fun and the most pressing problem in neurology is that most neurological diseases are clinically diagnosed. We need more precise diagnostic tools to know who the patients we are trying to treat, from there what pathogenic process we are treating, and from there how we can treat the exact mechanism of the disease. This is particularly relevant in neurodegenerative disease in that the emphasis on neurodegeneration is not just about normal aging. It is embedded in the biological dysfunction way before symptoms begin appearing. Catching those patients with the disease before symptoms arises is the key to effective treatment.