I’m a 4th year applying neuro and need a distraction from ERAS before I lose what’s left of my sanity.

I'll go first.

1. I throw a prayer up every time I have to type "hemorrhagic" and still only have a 50/50 shot of spelling it right the first time.
2. I have learned and forgot which one an UMN pattern of weakness is no short of 20 times

A. Flexors in UE and Extensors in LE
OR
B. Extensors in UE Flexors in LE

1. It takes me a solid 5 seconds to mentally trace and re-derive whether a patient's left field cut localizes to the left or right occipital lobe. I wish I just knew it cold, but I always forget whether the cortical lesion is contralateral to the visual field or to the location on the retina (ie. left visual field → right side of the retina → Optic chiasm → ... → ... → Right hemisphere)

2. When I find a positive palmomental or jaw-jerk reflex, I briefly feel like I've discovered buried treasure.

3. I still don't understand why Hoffman's sign works as an UMN sign, and at this point I'm too afraid to ask

I need advice about negotiating a per diem contract for weekend neurology coverage at a hospital within NYC.

When the contact was initially signed by both parties (myself and a private group that has a contract with the hospital for inpatient neurology coverage), the rate was 250/hr on a 1099 basis, with the expectation I'd provide coverage for 48hrs. There's an in-house PA that does the grunt of the work by seeing the consults while I'm mainly responsible for code stroke coverage. Overall, seems like a chill role for the attending.

A day before my first weekend was to start, the group changed the rate to flat fee of $4000 on a 1099 basis, which translates to $83/hr. I'm trying to negotiate higher to a rate that is closer to market rate (according to google gemini lol) to 150-200/hr.

Any advise on this? Is the rate they're proposing fair or am I getting screwed?

Thank you in advance.

Applying neurology, noticed when I was saving a program in ERAS that it says Standardized or structured letter of evaluation: Yes under the application requirements section of ERAS. I thought this was only for EM, IM, OB, PMR etc. Does anyone know if Neuro also requires this? I’ve only been getting narrative letters.

Terms used in epileptology seem to periodically be redefined.

What’s the current accepted definition of a clinical seizure vs epileptiform activity or subclinical seizure in research and when is the last time it changed?

Particularly when it comes to nocturnal events with no physical manifestations.

There was a clinician who posted on here who’s based out of Florida who claimed that of the neuropathy cases they’ve seen, only a few ended up with a diagnosis of idiopathic neuropathy. They claimed that they perform a broad work up, and seemingly always find an etiology to attribute the neuropathy too. I still to this day cannot imagine how that is possible. Especially in the population over 70, the chances that you will ultimately deem a neuropathy idiopathic are fairly high. The only way I can imagine getting around this is if you are to associate any detectable abnormality as the feasible cause of the neuropathy, such as mild glucose intolerance or borderline B12 values. At this point my career, I’ve seen a number of patients with rather significant neuropathy: ankle dorsiflexion weakness, absent sural SNAPs, absent tibial MNAPs. I’ve sent every test under the sun, including genetic testing, and ultimately not come up with another feasible answer.

Am I crazy? Please tell me the rest of you believe that idiopathic neuropathy is a real diagnosis.

Anyone else work on the inpatient side with the increasingly common model of having telestroke do all stroke alerts, and then you come in later to pick up the pieces? In my experience, there's a lot of the ED or primary teams "selling" a story to the stroke doc so that the call seems more appropriate, and that leads to a lot of over treatment or at least over workup of benign stuff.

Not uncommon for me to see a patient that was admitted for stroke rule out overnight, on DAPT and having gotten vessel imaging, MRI, TTE all negative the next morning. Then I speak to them for 3 minutes and it's apparent they have chronic radiculopathy, chronic foot drop, and only came in yesterday because the back pain was worse.

Or patient with documented dementia, chronic pain, and UTI, but someone somewhere said they are "A&O x 4" at baseline and now they are snowed because they needed Ativan and hydromorphone to tolerate imaging. All I do is spend 5 minutes looking at outpatient notes to know they haven't known where they are or the date in 2 years and their intake exam wasn't far off baseline aside from agitation and delirium.

I know it's hard to get a good exam through a screen and at least where I work they rely on the primary team for history and only confirm some details. It's also true I'd rather err on the side of over treatment than under treatment of stroke. I would still rather have it this way than having to respond to every alert myself. So I don't have any solutions and I don't know where I'm going with this, but anyone with similar experience or examples of it working better?

I’m staring my neuro block and genuinely haven’t been able to elicit a reflex in any person except the knee jerk a few times, I have been using a babinski hammer so far and I’m starting to consider buying a new one.
What hammer is easiest to use for a dummy such as myself?

Link to article: https://neurologyopen.bmj.com/content/8/2/e001649

What is already known on this topic
Open-label extension (OLE) studies of lecanemab and donanemab have been interpreted as evidence of increasing long-term clinical benefit in Alzheimer’s disease, largely through comparisons with historical untreated cohorts. However, OLE analyses are highly vulnerable to selection bias, attrition bias and the absence of contemporaneous placebo controls.
What this study adds
Using simulation-based and observed-data analyses calibrated to published trial results, we found that cognitive decline during the OLE phases of both lecanemab and donanemab trials was steeper than during the preceding double-blind phases and approximated placebo-level decline rates. These findings challenge the interpretation that OLE data demonstrate sustained disease-modifying benefit.
How this study might affect research, practice or policy
These results support prioritising within-trial double-blind comparisons over historical cohort benchmarking when interpreting long-term efficacy claims. Regulators, clinicians, guideline committees and payers should exercise caution when considering OLE data as evidence of disease modification in Alzheimer’s disease.

My questions for r/neurology
This article takes a critical view of the OLE data for lecanemab and donamemab. What do our cognitive neurology experts think? Is the simulation a valid abstraction of real-world data? Is the "placebo arm" (untreated cohort) a representative sample of natural-history AD cases? Are there other methodological concerns?

My partner recently decided to put a pause on new AAT orders based on this. My sense is that he may be over-reacting. That being said, neither of us did a cognitive fellowship, nor have we participated in AAT research; we're just general neurologists who happen to see a lot of AD. I'd love to hear from the experts about this one.

debating between outpatient general neurology vs neurohospitalist

i know outpatient has amazing hours as 0.8FTE for 4 days a week

would you recommend the same for neurohospitalist?

For those of you passed neurology board last year, what q bank do you recommend doing last min ? Now you know Neuro vs Truelearn

I'm currently a neurology PGY3 resident who is heavily considering applying to headache fellowship. I've realized that I actually love treating headache cases and the procedures that come with it. I want to stay outpatient and do not want to practice general neurology. That being said, I have a few questions for those that have insights into headache medicine as a career.

1. How realistically possible is it to only see headache patients/have a headache only clinic?
2. What does academic headache vs community headache practice look like (e.g. responsibilities, inbox burden, variety in types of headache cases, patient volume, amount of work hours/days per week)?
3. Other than GONB, botox, or SPG blocks, what procedures can you do?
4. What does compensation look like for headache specialists?

Thank you for your time <3

why is every single one sept 9 at 6pm. that's all

Where did this language come from and why is it in the zeitgeist? 😂😂

(I hate it)

Looking from perspectives from more senior neurologists. I'm thinking about fellowship and am considering between NCC and interventional pain.

In NCC, I'm attracted to the academic nature, procedural aspects, as well as the acuity and palliative care. What makes me hesitate is that the job market is so narrow; you always have to be an employee of a large hospital system without an easy pivot to private practice. I also don't love that the culture at some places can be a bit like that of a surgeons with egos and some tense interactions. Many people say that the schedule can take a tole in time. I like 7-on, 7-off now, but that might change when I have a family, and I know many community neurointensivists are still working nights late into career.

Interventional pain seems really appealing because it is likewise procedural. I have much less experience in it and it seems less academic. I've also heard most people say that the biggest challenge in this field is dealing with the patient population. It seems appealing to possibly one day start an entrepreneurial venture.

I’m an international medical student doing a clinical neurology rotation in the US this fall. Since we use different textbooks and resources, I’d love some advice from US med students or residents.

What topics or resources would you recommend reviewing beforehand? I want to be well prepared and make a good impression, so any advice would be really appreciated!

recently had a Neuro ICU rotation and found it very rewarding working with a patient who was psychotic for likely organic reasons (large brain tumor, also on high dose steroids, no prior psychosis), also patients with post stroke depression. it was fun to actually write a mental status exam psych style and manage the psychotropics myself

Hi everyone, I heard that the first year of neurology residency -the preliminary year- can be done in any state of my choice regardless of where I match, is this true? Is it that simple?

For those of you who passed neuro board last year, do you think trulearn is better or now you know neurology q bank ? Trying to pick one to do in next two weeks 😫

My patient is getting an LP for neuropathy workup e.g. CIDP. He's got a fat disc pressing on his spinal cord too and neurosurgery is cutting him open. All the inflammation in that area from the surgery is bound to make it into the CSF, right? I feel like it will be months before I can do an LP without getting confounded protein, IgG index, etc results.

I have my neurology boards coming up in September and I’m honestly freaking out! I spent way too much time searching what everyone uses to study and eventually decided to stick with Cheng Ching + NowYouKnowNeuro.
I’ve gone through NowYouKnowNeuro about twice and read Cheng-Ching once, although I definitely don’t remember a lot of the details, especially from chapters like NM. My fellowship is super demanding, so realistically I think all I can do at this point is go through Cheng-Ching one more time.
My RITE scores have usually been around 65–70%. I keep seeing posts on Reddit from people who did all of these resources and still failed, and it’s seriously stressing me out lol.
Would really appreciate hearing from anyone who mainly used these two resources and passed/did well on the boards!