The Good, the Bad and the Ugly of the NIHSS: Time for a Change?

August 31, 2021
The NIHSS remains the fundamental assessment of stroke severity. However, some have called for modifying the NIHSS to better capture disability. Is it time to change the NIHSS?
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What Else Beyond the NIHSS Should We Be Doing Clinically?

August 24, 2021
The NIHSS was a research tool meant to limit variability and provide uniform quantifiable assessments  of stroke severity.  As the de facto standard for stroke exams and scores, it has withstood the test of time.  However, there is more to the assessment of acute stroke severity and this podcast takes a deep dive into what else we need to be doing besides the NIHSS.
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The Clock Is Dead - The Reign of Tissue Imaging

August 17, 2021
Mismatch is your friend if you want to treat acute stroke patients beyond 3 hrs. While the clock was once the king, tissue imaging may now define what brain is salvageable and what has been lost. Listen here and see if you agree that the clock is dead in stroke.
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Defining the SOC - Is 4.5 Hrs the Real Answer?

August 10, 2021
The standard of care can feel elusive. Listen here as Dr. Knight shares his expertise regarding the definition of the SOC in extended window therapy for tPA. It's not a simple question and Dr. Knight is the one to answer it.
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How Do I Identify Patients at Risk for a Secondary Event Following an Initial Acute Ischemic Stroke?

August 3, 2021
Identification of patients at high risk for secondary ischemic event, after initial event or post TIA...is minimal tissue damage really that big of a deal related to secondary stroke? Drs. Galen Henderson of Brigham and Women’s Hospital and Jordan Bonomo of the University of Cincinnati discuss key perspectives from a neurocritical, emergency medicine, and stroke perspective related to this important area of medicine.
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Jun 8

CT Angiography - What Should the Rest of Us Know?

Haemin Go posted on 6/8/2021

Moderator: William A. Knight IV, MD, FACEP, FNCS
Other Participants: Achala Vagal, MD, MS

Neuroradiologist Achala Vagal, MD, discusses the fundamentals of CT Angiography for non-radiologists in podcast recorded with Dr. William Knight. Dr. Vagal decribes her techniques and approach to efficiently reviewing and interpreting a CT Angiogram of the head and neck in suspected stroke patients. Drs. Vagal and Knight review the checklist approach to minimize errors of omission, MIPS, and the challenges of difficult lesions such as M2 occlusions. They agree on optimal communication with the consulting radiologist, and discuss the benefits and pitfalls of artifical intelligence radiology software.

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2 comments on article "CT Angiography - What Should the Rest of Us Know?"

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Mohammad Kassem

I'd love to hear what your personal checklists are that you have found successful when reading a CTA. Thanks!


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William Knight

Great question! Here is Dr. Vagal's approach to having a systematic evaluation of CTAs - particularly for a non-radiologist:

1. Look for the LVO (ICA/M1/basilar).

2. Check the MIPs for smaller vessels such as M2

3. Check the MIPs for collaterals/decreased branching of M2 (as we know M2 occlusions are hard and easy to miss)

4. Check CTA source images for ASPECTS, especially if NCCT is normal.

Hope this helps!
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