I am a veterinary neurologist/neurosurgeon. For background, this means I completed veterinary medical school, then residency, then sat boards. In vet med, neurology and neurosurgery are lumped together in the same specialty. I am faculty at a large university with a teaching hospital. I have a heavy research appointment that means that my clinical effort is 30%.

In academic vet med, faculty rotate on and off clinics on a weekly schedule, generally correlating with the block schedule for students. At my institution, student rotations are two weeks long. Right now, this means I will do two weeks of clinics every 6 weeks or so, for a total of 14 weeks on clinics per year. As you can imagine, this means on those off-clinics weeks, I’m doing a lot of clinical work, mainly answering client calls/emails. This is especially true for seizure patients.

I have a lot of autonomy and likely can rearrange how I apply my FTE. My research is very translatable, so I work with a lot of MD researchers, who comment on how disruptive my current schedule must be. It is! It sounds to me like academic MDs don’t schedule clinic weeks, but rather clinic days. A hypothetical weekly schedule may be something like: Monday receiving, Tuesday procedures, Wednesday admin, Thursday and Friday research. I am considering switching to something similar. My question for neurologists is regarding patient follow up/communication on your off-clinic days, especially for breakthrough seizures that need some sort of a reply. Do you turf the callback to someone else? Wait to respond until your next clinic day? Do you create your weekly schedule differently than how I generally described? How do you balance your FTE obligations? Thank you!

Hey brain peeps. A few questions that have been on my mind for a long time as someone in the ED/ICU.

1. In general, what is your definition of a non-focal neurologic examination?

For example, a hard motor deficit is what many non-neurologists and maybe even neurologists would colloquially refer to as a “focal” deficit. But a limb that hits the bed could be attributed to like 3-5ft of neurons from cortex -> subcortical -> spine -> periphery. In my mind the most focal lesions are syndromes where association with other findings is what narrows down focality (ie. limb weakness/sensory with aphasia NOS, isolated weakness without sensory loss, weakness with features of movement disorder, weakness with contralateral cranial nerves, weakness with sensory level.)

Also some signs like an isolated, non-fluent, expressive aphasia would localize to Broca’s but most people would describe this as “non-focal”.

Essentially in my mind I think that since so much of neuro seems subjective to the outsider, the term “focal” is used instead of the term “objective” to lend credence to a finding that we know to definitely be true.

2. What “focal” neuro findings in an otherwise globally altered patient would push you to get a CT Head?

This question arose in something I posted in r/medicine about the utility of CT Head in patients with nonspecific AMS in the non-trauma setting. Most people and one paper made a good argument that the yield for patients with a “non-focal” exam is extremely low, which I agree with.

But nobody has yet answered to say what their definition of a “focal” neuro finding in altered granny would warrant a CT Head?

Would really appreciate your thoughts!

I know a neurologist that often orders an extensive autoimmune workup to rule out any autoimmune component of undiagnosed neurological diseases. I know another neurologist who used to order ECHOs to work up a cardiogenic component of POTS/OH but stopped after he realized that many of those patients weren’t following up with cardiology. Also, sometimes the ECHOs would show incidental findings he didn’t want to be responsible for.

Just curious to hear any other stories out there!

Psychiatric disorders are caused by neurological issues and most medication used for neurological illnesses is also used for psychiatric illnesses so why do we need a whole different speciality to treat them? I feel like making psychiatric problems a whole new category actually stigmatizes the mentally ill because people who aren't particularly educated think mental illness is not real illness and that it's all in your imagination and you can just snap out of it. I know there aren't really any biological markers and the chemical imbalance theory is not particularly valid but since medication helps that alone should mean that there's something wrong with the brain and mental illness is actually physical illness.

I would love to know the ballpark starting salaries at some of these well-funded academic centers like BNI or Mayo Scottsdale. Also, how is the culture? If anyone has worked at one of these institutions, past or present, and would be willing to privately message me that would be great. Thanks!

Has anyone taken the course or recommend it? I’m from a smaller town in California; currently in community college taking pre requisites for a UC. The hybrid work would fit my schedule perfectly but it seems a bit too good to be true. They are accredited by ACCET but I want to know more about it before possibly jumping in. Was thinking more on the lines of becoming an EEG technologist in the meantime before medical school.

Thank you!

Hi all,

wondering if anyone has resources for improving on stroke alerts for pgy2 level - anything from localizing to neuroradiology would be super helpful to build some extra confidence. thanks!

Does anyone know of a way to compare the similarities and differences of EEG signals to different stimuli?

I'm trying to build a categorisation of a range of stimuli based on how similar and different their EEG signals are. Ideally this would take into account spatial, temporal and wave-form based info the EEG signal encodes...

Thank you!!

Since residency, I have believed that Neurocritical care is more medicine than neurology. I believe it should be a medical critical care fellowship or such services should be run by medical ICU specialists with neurologists as consultants.

Neurocritical care is a departure from classical neurology. Neurocritical care is devouring residency manpower with long stressful hours.

What are your thoughts?

I'm a resident who's becoming more and more sure I want to do interventional but don't have great mentors at my institution. Can anyone point me to where I can find any of the following information on fellowships:

most rigorous, i.e. high case volume, independence

most prestigious

greatest research output

most likely to take neuro residents

I'm on the east coast, would potentially be open to looking west if necessary to meet my goals but would rather stay on the east coast and ideally the NE/Mid-Atlantic. I love research and it'd be great if I can find somewhere I can be a part of that, but would prioritize technical training over that. Not sure how dramatic the trade-off is in this field.

if there's anyone in fellowship or attending, who feels like answering some of my other questions via dm, I'd also much appreciate it.

thanks in advance for your help

Hey, neurologists of Reddit —

I’m trying to gain a better, high understanding of MS lesions and treatment mechanisms. I am seeking general understanding, not personal medical advice.

Please correct me if you see any errors in my post. I’m not a doctor, so I’m just trying to make sense of what I’ve read.

Composition of active lesions

My understanding is that active MS lesions are generally comprised of T-cells, B-cells, macrophages/microglia, oligodendrocytes, astrocytes, and endothelial cells/pericytes.

Furthermore, the volume of T-cells in lesions seems to be higher than that of any other cell type (around 50-75% of a lesion’s makeup).

Cell function in lesions

Interestingly, at some point during my reading, I came across an article which (if I remember correctly) stated that while we used to think that T-cells were the real culprit in MS, more and more evidence is pointing to B-cells as the particularly detrimental agent in this disease.

Treatment

The success of therapies like Ocrevus and Kesimpta seem to support this — although of course there isn’t a 100% success rate for any treatment so far, and even these therapies don’t cure the disease for people who find success with them.

Question

With all that in mind, I am very curious as to how B-cell treatments in general can be so effective given that they seem to comprise a relatively small percentage of lesions.

I would assume that since T-cells are so predominant in lesions (esp. compared to B-cells), we’d be more concerned with T-cells being released.

But correlation is not causation — so to correct my assumption: just because a high volume of T-cells is correlated with demyelination, doesn’t mean that those T-cells are causing the demyelination.

This leaves me wondering: Is there strong evidence to suggest that the B-Cells themselves cause demyelination, and that T-Cells serve a different function (or are a less powerful agent) in the lesion?

Or is there another factor that could make B-Cell targeting therapies so much more effective than T-Cell targeting therapies in preventing disease progression?

Have a job interview coming up and wanted to know what questions should I ask from the director. I am a J visa holder currently in stroke fellowship and interviewing for neurohospitalist positions.

Going out on a limb here. I'm new to EEG and for a solid stretch was collecting great, clean data. I'm not sure what changed, but the data has had much more noise for the past 4-5 recordings. Can anyone help me identify what these artifacts are?

https://preview.redd.it/9skryqg4z53e1.jpg?width=2262&format=pjpg&auto=webp&s=ea92d26057e423f2fbbe47d9ce5229f8ad8135cf

Not even sure if I'm in the right group to ask this, but a random thought has been bouncing around my head that I'm craving an answer to, so here goes...

Is there a "max capacity" for the human brain in regards to data / memory accumulation? From my limited understanding memories, feelings, emotional responses, etc., are for lack of better terms, "data" being stored in the form of neural pathways & connections right?

And sometimes we forget things if those pathways aren't used frequently, but at the same time we can also remember things from long ago, which implies to me the layman that those pathways are still physically there, just kind of dusty & unused.

So if the brain is a "computer" in the loosest sense, does it have the potential to become "full", and if so, how does the human mind / brain react or "clear the cache" so to speak?

...the reason I even found myself on this rabbit trail was because I was watching some random show about a guy who was "immortal" and lived for thousands of years, and it occurred to me that in an extreme "immortality" scenario, that the human brain might just overload & crash at some point when a more than "normal" amount of data was being stored.

Sorry if this is a stupid question, but its been bugging me so I came here where those of you much smarter than me could possibly answer my idiotic question. 🤣

Cheers!

Very interesting article this week on Opioids and Cannabinoids in Neurology Practice by Friedhelm Sandbrink, MD, FAAN; Nathaniel M. Schuster, MD. The article contains some essential guidelines about the changing environment of prescribing opioids and their usefulness, as well as some of the risk on vulnerable populations. It also discusses some of the emerging uses of cannabinoids and some associated challenges. I hope you find this article stimulating! Continuum did this wonderful interview with the authors.

Can anyone guide me on westchester nymc versus UConn versus Michigan state

What programs are doing in-person interviews for residency? I know in the past Los Robles in CA, Prisma in SC, NYU (hybrid, some in person, some virtual) and this year Corewell/Michigan State is interviewing locals in person. Anywhere else?

Hello everyone. As the title mentions I am this year’s applicant for neurology. And I am absolutely devastated. As someone who had v minimal or nil guidance in terms of seniors pursuing usmle and none in neurology, I was too committed to pursuing neurology since my 2-3rd year of medical school. Worked and attended neurology classes, in the middle of duties,that were only for superspeciality residents in my country. Did USCE in the Us all in neurology, completed and submitted multiple projects, even as me in lead investigator and in neurology itself. Tried to pour my heart and soul into that one dream. But made one mistake, I was so fixated on getting there, that Anything else seemed unacceptable. I stressed and lost my mental health during my step 2 prep, leading to anxiety and sleep deprivation, that had resulting in a 15+ points drop in my step 2 result giving a score in early 240s. It came as a huge shock but I applied anyway, and now I have 4 interviews only. One from a prelim IM program. I am incredibly grateful for this as well, and Ik there are people who would really appreciate this a lot too. But I’ve gotten Ivs from 0 of my signals. And even my connections are not able to help with any IVs. The interviews went well. But as much as I know it is about quality over quantity, i think we know that I stand to get unmatched a lot at this point. I do not know where i will go from there. Another cycle with this kind of uncertainty. My scores wont increase, id still be visa requiring. I cant help but feel depressed, and so so down. Even the Ivs were half from v new programs. Although I like them and would love nothing more than to match at any of them, it just makes me questions about every program thwt didnt work out. Am i this horrible?

Coming from one of the best most difficult to get into colleges of my country for medical school to standing so close to getting unmatched all together is honestly nerve wracking. One day of mishap, one day of a cloudy brain, might now lead to a total collapse of a dream. Although I am 100% confident about thriving, really becoming a best version of myself in this residency and field, i cant help but feel like It is this field asking me to look away at some different.

Was anyone in a similar boat ever? Or knew anyone who were. This is the most horrible time of my life and I have no clue what to do.

Good night everyone. I am a neurology resident from Brazil. I'm looking to invest in a good ophthalmoscope during my neurology residency, to learn more and with quality. However, I'm in doubt about buying a Panoptic or a Panoptic plus. Could anyone who has used either version or both please help me? Thanks

Hi guys, I’m a second year Neurology resident in a hospital in Curitiba - Brazil.

I’ve been struggling to find the best literature to study during residency.

I’ve already read Blumenfeld’s neuroanatomy, and now I started Bradley Clinical Neurology, but I’m not feeling that it goes deep enough in its chapters, so I can become a true specialist. Maybe it’s just a false impression because I’m early in the book…

What you guys would recomend as a supplementary read in case Bradley starts to seem not enough?

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Hi everyone,

I’m a pgy3 in one of the programs in the north east. I’m applying for epilepsy fellowship in couple weeks, I’m interested in only 1 year programs with exposure to epilepsy surgery and IOM. Any input on which programs could fit this goal?

Also anyone knows anything about the program in Vanderbilt, UT southwestern (Dallas), UT Houston, University of Pennsylvania, NYU? Thank you!

My institution currently relies on TCDs, but we find them insensitive. I’ve read and heard about alpha-delta ratios (and potentially other EEG metrics) being used as an early warning marker, but I have not seen a way this is practically implemented without an army of EEG fellows doing the reading. Does anyone’s hospital do these, and if so, what’s the setup?

CvEEG for every SAH? Spot EEGs? Dedicated devices? Who reads the studies?

When do interviews for neurology stop going out? Have 4 interviews so far and wondering if I'm cooked.

The next article in the October 2024 series from Continuum is on Chronic Widespread Pain by Narayan R. Kissoon, MD. I know this is something every neurologist is exposed to frequently in their practice. I think this article does a great job discussing a number of syndromes and providing some guidance regarding treatment.

I'm sure this question has been asked a lot, but I was wondering if there were any residents from the "top" NYC programs (NYU, Sinai, Cornell, Columbia) lurking around who could give their opinion on whether you feel like you have adequate ancillary support, or if you feel like you're the one drawing labs/transporting patients and things like that?

Does anyone here have access to AGMA data for south region? Or how to get it?

I am an M4 applying neurology in this cycle and am currently trying to figure out a preliminary rank list. I am having trouble deciding how to rank newer programs. I think it is harder because the newer programs I am considering have decent institutional backing and already have several other residencies in place (ECU and Carolinas Medical Center).

I guess my questions are:

1. Have any of you been the first class of your neurology residency program and how was that experience? Would you recommend/do it again?
2. Do you have any specific opinions about these newer programs (Carolinas Medical Center and ECU)?

Im planning on going into a naural-oncological pathway (in the surgical department), and ive beent hinking. As a senior in highschool, it terrifies me being away with suxh a high dream of doing this. Is going into something like this because of a genuine love and hobby something you should do, or should I focus more on something more achieveable?

I think this is mostly the fear of colleges, and lack of possible routs for me to take because i have a lower GPA and recognition in my class (despite being accepted into my state college on writing terms).