Stroke & cerebrovascular diseases

Released 20 Oct 2025

NIHSS hyperacute stroke examination (theory) with pearls & pitfalls

We’re very excited to present the first episode in the stroke and cerebrovascular diseases series! (As an overlap with our ongoing clinical method series). This episode focusses on how to perform a NIHSS hyperacute stroke examination accurately and quickly, and explains the rationale behind each item, how to examine each item correctly, and tips for remembering the NIHSS items, in order to better prepare you for your next stroke call/code stroke.

Correction: 19:30 Visual threat testing is for testing visual fields when the patient isn't properly responding to your initial standard field testing (not for when there is already an established field deficit in a cooperative and responsive patient); Correction: 21:31 Should say "retrochiasmal components" (not "upper motor neuron components", oops!); Correction: 45:56 Same as for my initial correction.

https://open.spotify.com/episode/2mk27kIidaNCCNa9VSKHue?si=t6mKeB0jQuibxUSujjKC4w

Released 27 Nov 2025

How to run a stroke call/code stroke & decision-making re. thrombolysis/thrombectomy eligibility

Hope you’re ready for an important one! In this next instalment in the stroke & cerebrovascular diseases series we discuss how to effectively run a stroke call/code stroke, focussing on establishing the time last seen well (or midpoint of sleep), the baseline function (modified Rankin scale; mRS), stroke deficits (National Institutes of Health Stroke Scale; NIHSS), relevant comorbidities, & anticoagulants & antiplatelets. This then allows us to quickly and effectively make a diagnosis and a management decision in regard to whether the patient is eligible for thrombolysis &/or mechanical thrombectomy (endovascular clot retrieval; ECR). As always, the episode is presented in an accessible, story-based way with anecdotal experiences being used to supplement a discussion of the literature/evidence-base, in order to make the content memorable and practical, so that you ace your next stroke call/code stroke & save your patient a few hundred million neurons in the process! This episode is appropriate for all audience members from medical students through to neurologists.

https://open.spotify.com/episode/3tMxAfhcCxZiAZmjUh2fkf?si=6zP2P2GPSA-XM3hLzwIrKg

Released 2 Dec 2025

Tenecteplase for stroke to 24 hrs: TRACE-III study journal club

We’re thrilled to present our first journal club episode, focusing on tenecteplase for ischaemic stroke in the 4.5-24 hour time window in patients with large vessel occlusions (LVOs) in whom mechanical thrombectomy is not an available option (the TRACE-III study, published in the New England Journal of Medicine; NEJM in 2024). This is a landmark study extending the thrombolysis timing window beyond 9 hours for the first time, although with a number of caveats as discussed in the episode. This episode, in addition to teaching you about the evolving landscape of hyperacute therapy options in stroke, teaches you how to critically evaluate a medical journal article, and how to then apply the journal article to your clinical practice, and determine in what ways (if any) that the article is practice changing. This is a more advanced episode, better suited to neurology trainees and neurologists, although more junior audience members will also find it valuable through its global significance in extending the thrombolysis window in places where mechanical thrombectomy is not available, and through its providing a step-by-step worked example in regard to how to critically evaluate a neurology article, an essential and highly transferable skill across clinical medicine as a whole.

Correction: At various times when discussing the results section, I refer to the ‘placebo group’ (as a force of habit, apologies!) as opposed to correctly saying the ‘control group’ in this case, given that this was an open-label study at the time of randomisation (not placebo-controlled) and then later blinded at the time of outcome measurement and statistical analysis, as was discussed in the episode.

https://open.spotify.com/episode/2gK43yRNSwetjMDjdu23er?si=r7UAENQdQRentdjGsnsV5Q