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My neurological hobby horse
Treating by numbers
  1. Timothy J Counihan1,2
    1. 1Department of Neurology, Galway University Hospitals, Galway, Ireland
    2. 2School of Medicine, National University of Ireland Galway.
    1. Correspondence to Dr Timothy J Counihan, Department of Neurology, Galway University Hospitals, Galway, H91 YR71, Ireland; timothy.counihan{at}hse.ie

    https://doi.org/10.1136/practneurol-2018-001939

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      Registrar: ‘Hello, am I speaking with the consultant neurologist on-call?’

      Consultant: ‘Regrettably! Yes that’s me. What is it?’

      R: ‘Hi this is Dr Richter, medical reg. on call. Sorry to disturb you so late, but we’ve got a FAST1 positive in A&E.’

      C: ‘A what?’

      R: ‘A FAST-positive patient.’

      C: ‘I assume that’s worse than a FAST-negative patient then. Go on.’

      R: ‘Well the NIHSS2 is 24 but her GCS3 4 is 12 currently. Before we got the CT, I was worried about a subarachnoid, because her Hunt & Hess5 was 4.’

      C: ‘Gosh.’

      R: ‘But thankfully the CT showed no bleed, but the ASPECTS6 was 6.’

      C: ‘Six, did you say? That doesn’t sound too bad. At least it’s not 10 or something.’

      R: ‘Actually 10 is a normal score. You really don’t want an ASPECTS lower than 6.’

      C: ‘I see. So what are you recommending to do?’

      R: ‘Well, time is brain, Professor, and I think it would be good to keep our door-to-needle stats …

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      Footnotes

      • Contributors The author is the sole contributor to the text. Mr Aongus Collins (collaborator) provided the figure.

      • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Patient consent Not required.

      • Provenance and peer review Not commissioned. Externally peer reviewed by Charles Warlow, Edinburgh, UK.

      • Collaborators Aongus Collins.

      Linked Articles

      • Editors’ commentary
        Highlights from this issue
        Philip E M Smith Geraint N Fuller
        Practical Neurology 2018; 18 347-347 Published Online First: 17 Sep 2018. doi: 10.1136/practneurol-2018-002077