Abstract

A paper that changed my practice: which tugboat turned the Queen Mary? My immediate thoughts revolve around such issues as the nature of my practice and any really dramatic changes that have occurred over the nearly 20 years since I became a neurologist. If they have occurred, were they in clinical assessment and diagnostic approaches, general management or treatment? Mmm.

To lay my cards on the table: I am an academic neurologist who sees patients every day as inpatients or outpatients, mainly those with an acute stroke, but also patients with general neurological problems. Upon reflection, there is not much doubt that the most dramatic change in my practice pertains to the former group, those who have had an acute stroke. When I first became interested in this aspect of neurology, what mainly appealed was the myriad of clinical presentations and subtypes of stroke and the clinical challenge of determining