Phil Bilodeau, MD
@phil_bilodeau
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Neuroimmunology 🧠 🔥 clinician scientist @MGHNeurology , @BWHNeurology . Grad of @harvardneuroMDs & @mcgillmed .
Boston, MA
Joined December 2011
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Pinned Tweet
Why has no one thought of opening a bar near a hospital and calling it PubMed
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It took 2 weeks of vacation for me to realize that I did not in fact lose my passion for medicine and neurology, I was burned out. Burnout is insidious. Everything suddenly seems like a chore. It’s no longer about helping patients or working through a tough case, it’s about
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Hey there
#NeuroTwitter
! Let's chat about one of my favorite topics: optic neuritis 👁️🔥
Differential is short
1. MS/CIS
2. NMOSD
3. MOGAD
4. Idiopathic
5. It's not optic neuritis (e.g. NAION, AION, CRAO/BRAO, mitochondrial, malignancy) *More common than you might think
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@AlexWW1701
@jpbrammer
@ShirleySTANson
This is incorrect. As a neurologist, I can confirm that dementia, especially frontotemporal dementia, absolutely changes one’s personality, and can make patients very belligerent even when they were not before diagnosis.
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Still don't understand why people still say there are no Rx in neurology when we have 17 disease-modifying drugs for MS, >20 AEDs, 2 new treatments for NMO approved in the last year & extended window (24h) thrombectomy for stroke
#MedTwitter
#neuro
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If you think someone is having a seizure, write exactly what you’re seeing instead of “the patient started seizing” - Your friendly neighborhood neurologist
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Thrilled to have the opportunity to stay
@harvardmed
@MGHNeurology
@BWHNeurology
for neuroimmunology fellowship!
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“Loading” and “with 1 g IV Keppra” are mutually exclusive
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When the neuromuscular attending explains why it’s a lower trunk plexopathy
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Instead of neuroimmunologist, I wanna be called an inflammatory neurologist
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I said it before, I’ll say it again. ID doctors are always so thoughtful, thorough and all-around amazing. We need a national ID appreciation day.
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@DTylerKingDO
In Canada, family medicine is its own specialty, every medical school has a Department of Family Medicine and we don’t have internists doing primary care. It is the most important field in our medical system and totally deserves its own Department.
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finishing that H&P or writing that discharge summary. You feel like you just can’t keep up or don’t want to. We don’t need more wellness sessions, we need more time off.
#MedTwitter
#MedEd
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Yesterday an attending neurosurgeon treated me like a colleague and I must say, it was refreshing. These interactions shouldn’t be the exception, they should be the norm:
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@ArmandDoma
@ArmandDoma
fentanyl does not “get into basically every drug”. This is a common misconception which has never been proven and makes no sense economically (why would the dealers give out expensive drugs).
@RyanMarino
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Why did I pick a specialty where I have to know the brachial plexus, developmental milestones and lysosomal storage diseases 😩😩
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The olfactory nerve really made a come back with COVID after years of being neglected
#MedTwitter
#NeuroTwitter
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3 years of residency has taught me to over guess. “Are you the department chair? Oh you’re the intern, got it thanks”
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Two years ago I learned that I matched
@harvardneuromds
. Never thought a first gen French Canadian small town kid could make it to the big leagues, but here I am 🙌🏻🙌🏻. Incredibly excited to work with the new neurology class; congrats on your match!!
@MGHNeurology
@BWHNeurology
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I was once screamed at by OBGYN because I didn’t do a pelvic exam on a neuro patient before consulting them for massive vaginal bleeding. I will die on this hill 1) You should never want a neurologist to do a pelvic exam and 2) It’s invasive and uncomfortable
Why are you consulting OBGYN for vaginal bleeding without doing a pelvic exam? Do you also consult cardiology without listening to the heart?
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Check out our new paper in
@MSJ_Research
- we compared the most commonly used DMTs in
#MOGAD
and found that IVIG was by far the most effective, with an ARR of 0.13. MMF was second, and B-cell depletion was the least effective.
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Thank you
@AANmember
#AAN2023
for allowing me to present my work on MOGAD! Huge thanks to
@NegarMowlazadeh
@mlevy18
@Gauruv
as well
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When someone calls you for a consult, they’re asking for help. No one is trying to hurt you.
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An accent is not a measure of intelligence. It infuriates me when people speak down to non-native speakers. Try and move to a different country, with a different culture & foreign language and see how it goes.
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The ACGME question "Has your program instructed you on how to minimize the effects of sleep deprivation on patient care?" has never failed to irritate me. Why is
@acgme
ignoring decades of literature on the effects of sleep deprivation on cognitive function?
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Congratulations to everyone who matched today! Future neurologists 🧠, welcome to the best specialty!!
@AANMember
@NMatch2021
#MedStudentTwitter
#Match2021
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Last night the attending pediatric neurosurgeon stayed with us for several hours in the middle of the night as we tried to save one of his patients just to provide support. His dedication and kindness were inspiring.
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A little over a month into neurology residency, and I've already been humbled many times by patients getting better when we thought they wouldn't. Neuroprognostication is hard y'all.
#MedTwitter
#NeuroTwitter
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Why can't we have access to EEG 24/7? We have to make decisions completely blindly overnight, and patients suffer.
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So what's the deal with the red nucleus and why is it super helpful for localization?
#MedTwitter
#NeuroTwitter
#MedEd
#neurology
#medstudent
#MedStudentTwitter
#tweetorial
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B12 may be normal with NO poisoning! Important to check MMA and homocysteine, which should both be high (often strikingly so)
A previously healthy woman presents with weakness & unsteady gait six weeks after surgery.
On exam she has a broad based gait & decreased sensation in her lower legs.
Blood smear reveals the following.
What anesthesia agent did she receive & how does it explain her symptoms?
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Absolutely incorrect. Can be started day of for punctate infarcts and may need to wait >14 days if large with petechial hemorrhage
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It’s only Bell’s palsy if it comes from the Bell region of France; otherwise it’s just sparkling facial palsy
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Welp. I canceled my trip back home for Christmas. I’ve only seen my family once since the beginning of this pandemic. I am so, so tired
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Amazing plenary talk by
@harvardneuromds
future neuroimmunology fellow Prashanth Rajarajan on outcomes after ICI treatment in patients with MS
@AANmember
#AANAM
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We just got our first portable MRI
@MGHNeurology
2 weeks ago. The poor sales rep had to put up with a bunch of neurologists geeking out and looking way too excited, myself included.
#Neuroimaging
#NeuroTwitter
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When they got a CTA head without CTA neck and they call a stroke consult
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Rough last few weeks, still trying to learn self-compassion and forgiveness and to treat myself the way I try to treat others.
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Can ED Twitter stop being so condescending to neurologists?
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No one thinks that hospitals are purposefully excluding residents. What hospitals are not doing, though, is purposefully including us. They don't consider our insane schedules, dismal salaries and vulnerability. We're secondary, an after-thought. That's why we're upset.
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Powerful story. I had lots of deaths in my family during intern year and
@mghmedres
chiefs Alyssa Castillo, Kelsey Hills-Dunlap, Pierre Ankomah and Aisha James were always incredibly supportive and understanding
4 years ago tomorrow would have been my 1st
#residency
interview, at
@mghmedres
. I know this because 4 years ago today my dad died unexpectedly in Denver while I was in Boston. I cancelled the interview from the tarmac at 6am the day of, and flew home.
It’s a whole 🧵
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But how could the USMLE know I can speak English without a $1200 test?
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We have to stop with the ageism. Who cares if the patient is 85? Thrombectomy might mean 10 years of independence instead of 5 years of severe disability
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Why aren’t pharmacology lectures in med school taught by pharmacists? They know the pharmacology, the indications, side effects and literally everything else about meds. Pharmacists are awesome and we should take advantage of their expertise.
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@ClementLeeMD
@bfhermann
Depends what you mean by herniated disc/stenosis. Most wouldn’t debate the benefit of surgery for acute disc herniation/severe canal stenosis & weakness. The debate is really for lumbar radicular disease & LBP. Location, exam & level of disability matter!
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@DavidJonesBrain
@CorriveauNick
Disproportionately enlarged subarachnoid space hydrocephalus (DESH)
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@RBeechPharmD
I’m sorry that happened to you and glad you’re doing so well! A neurologist, of all people, should know how important physical therapy is and how much better patients get
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I’m exhausted. This isn’t what I expected residency to be. I hate this pandemic
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Fantastic thread. As
@AaronLBerkowitz
likes to say, "It"s never CNS vasculitis" and epidemiologically, much more likely to be CAA-ri. On the differential for rapidly progressive white matter changes and change in mental status is also CNS lymphoma, particularly intravascular
🧯Tx:
-5-day high-dose corticosteroids (500mg-1g / day) w taper
-If no improvement, revisit Dx, brain Bx, consider immunosuppression (e.g. cyclophosphamide, 1-2 mg/kg/day PO for 2 weeks)
-Other immunosuppressives in refractory cases
@neuroimmunodoc
@phil_bilodeau
12/
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Your dizzy patient almost certainly doesn’t have vertebrobasilar insufficiency
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I recently read a note that said “the patient stopped seizing after rocuronium”
...
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So shameless plug, Canada is a great country, democratic, peaceful transitions of power and all
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Concerning study from Denmark/Sweden. Authors found that pts who received blood from donors who later had 1+ spontaneous ICH (i.e ?CAA) had a >2 HR for developing spontaneous ICH. Can amyloid spread via blood?
@a_charidimou
@MarielKozberg
@guroledip
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Last night I watched as my patient started herniating in front of my eyes, pumping her with mannitol and hypertonic to try to temporize things without success. Medicine sucks sometimes.
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“Ok so just so I understand, you’re consulting me because the patient has a brain and you don’t understand it?” 😂😂😂😂
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Take a look at an interview I gave at
@ACTRIMS
summarizing our work on predictors of relapses & immunotherapy in
#MOGAD
.
@mlevy18
@NegarMowlazadeh
@DenisBalabanMD
@TheSumairaFDN
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#NeuroTwitter
what’s your threshold for empiric meningitis/encephalitis coverage? For me, encephalopathy/new seizure and fever without a clear etiology buys you empiric coverage
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Most memorable interview question I got
“So you trained in Canada. How do I know if you’re any good clinically?”
Most memorable interview question I got this year was opening zoom:
“what’s a northern girl like you doing applying to a southern place like this. We don’t interview Minnesota girls.”
It ended with interviewer questioning if I was truly in AOA like I would lie about that?
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This morning I was in bed with fevers, chills and myalgias and yet, I felt bad for not going to work. I’ve really internalized medicine’s toxic culture. Any tips from
#MedTwitter
on how to unlearn these irrational self-expectations?
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Today I mistakenly showed up to work an hour early and there’s no greater tragedy
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I really hope I’ll never be a resident’s 12th overnight admission
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Check out our editorial on relapse definitions in MOGAD. We argue that we should further characterize relapses as typical, polyphasic (> 1 in 30 dd) or triggered (e.g. steroid taper)
@EoinFlanagan14
@mlevy18
@NegarMowlazadeh
@DenisBalabanMD
@gsmanzano12
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@acweyand
How exactly did an ophthalmologist “work daily with the top stroke team”? This is so shamefully and purposefully misleading. There are literally pediatric stroke fellowships…
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@AJWPharm
I love to die on the CVA hill, but then I remember stroke doesn’t have a direct translation in French and the only term that exists is accident vasculaire cérébral 😬
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I love when my Apple Watch wakes me up post call to tell me it’s time to stand
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I was dictating and Dragon wrote serum awesome instead of serum osm and I kind of wish serum awesome was a thing now.
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@txhealthplans
Tell that to my epilepsy patients when you deny their antiepileptics and they get admitted with breakthrough seizures.
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Stroke neurologists, I see you
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Ventilation matters folks, it’s not all about oxygenation. Last night I diagnosed a patient with hypercarbic respiratory failure from neuromuscular disease. His sats were fine the entire time. Don’t wait, intubate.
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My approach to EEGs: if it looks like an EKG, that's not normal. Yes, I have a refined understanding of electrophysiology.
#NeuroTwitter
#MedTwitter
#Epilepsy
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Here we go again. Recurrent basilar occlusions and mural ICA thrombi with a side of ARDS. But omicron is mild right?
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Just got called a 'grantseeker' by a funding agency. Is it just me, or does that sound like a character class in Baldur's Gate or Elden Ring?🎮🗡️Next quest: Conquer the perilous realm of Paperwork 🖇️ and face the final boss, The Award Committee.
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We stand on the shoulders of giants like Marty - always the doctor, always the teacher & advocate. Neurology owes him a lot. May he rest in peace.
We are shocked today. I cannot begin to describe the impact Dr. Marty Samuels had on so many of us. I will share my stories when I find my words again. He was teaching us neurology till the end. We will miss him, his flair, his love for neurology and for teaching
@BWHNeurology
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Fresh off the press - we found that AQP4 immune complex stimulate Th17 release in a complement-dependent fashion in NMOSD. Congrats to Dr. Shuhei Nishiyama & the rest of the team for this effort!
@TheSumairaFDN
@guthyjacksonfdn
@wearesrna
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Neuro:
@AaronLBerkowitz
@caseyalbin
@Tracey1milligan
@RebeccaFasanoMD
@TheNotoriousEEG
@DrNicteMejia
All Star Physician Draft:
ID:
@IDdocAdi
Med:
@AllisonRBond
and
@gradydoctor
Haem:
@acweyand
Onc:
@marklewismd
Uro:
@AshleyGWinter
Ophth:
@DGlaucomflecken
Trauma:
@kari_jerge
Ortho:
@DrGolfShirt
Ped:
@DocAroundThClok
Path:
@DrFNA
Who ya got
#MedTwitter
?
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Medicine -> neurology: D5 infusions are now prohibited, and hypernatremia is desirable
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Myasthenia can be scary people, look up every medication you wanna give your myasthenics, or they’ll end up intubated
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@rabihmgeha
@DxRxEdu
9/10, they have diabetes. If rapidly progressive or with weakness, would think about an infiltrative process eg amyloid, myeloma with high output CHF, etc
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Oh
My
God
“Babe, have you seen the remote?
<deep sigh> “have you checked the post-central gyrus? That’s where you lost it last time”
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Testing CN 8 and 11 is almost always useless. There, I said it.
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I love how neuroradiology called me at 11:30pm last night and half excited, half surprised told me the MRI black blood showed vessel wall enhancement. For all the times we bring it up, it was actually primary CNS angiitis!
#NeuroTwitter
#MedTwitter
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Great news for patients - ravalizumab
@AlexionPharma
was extremely effective in NMOSD with 0 relapses in the treatment arm.
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President Biden signs an order banning the term “toxic metabolic encephalopathy”, leading the nation’s neurologists to go on strike
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Alright after having to re-schedule 4 times because of
#covid
, not having time to study because of
#residency
and having to schedule the exam before an ED night shift, I’m done with Step 3 🙌🏻🙌🏻
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Long-awaited results of CABANA trial: Catheter ablation for AF does not reduce primary composite end point of death, disabling stroke, serious bleeding, or cardiac arrest, but many patient crossovers during study
@JAMA_current
@HeartandStroke
@JWatch
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Life of a resident: Step 3 today, followed by an ED night shift.
See you on the otherside!
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I always have so many great plans when I'm post call, and end up eating chips and watching TV with the lights turned off.
#MedTwitter
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If we’re gonna call strokes CVA, petition to call MIs acute cardiovascular accidents and AKIs acute kidney accident because why not
Credit
@PriyaSrikanth9
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Another one - here, we found that a polyphasic first attack and high CSF protein increase the risk relapsing course in MOGAD while immunotherapy after index event decreases it. Work led by the amazing
@NegarMowlazadeh
.
@TheSumairaFDN
@guthyjacksonfdn
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My approach to work-up:
-MOG IgG and AQP-4 IgG, ideally via cell-based assay
-CSF with routine studies, OCB, IgG index
-Hepatitis serologies, JCV antibody inhibition assay in anticipation for immunosuppression
-MRI cervical and thoracic spine
-ACE/Lyzozyme generally low yield
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To DAPT or not to DAPT, that is the question (sometimes)
Whether ‘tis nobler in the mind to heparinize that hot carotid (it is)
Or to dissect away that sea of plaque (yes!!)
And of course, tPA, thrombectomy and ASA.
#Stroke
@MGHNeurology
@harvardneuromds
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Neuro curbside: It’s almost certainly not HSV if the patient’s been confused for a week and now has a fever. Untreated HSV encephalitis has a mortality of 70-80%.
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