Introduction/Aims It is unknown if patients with neuromuscular diseases prefer in-person or virtual telemedicine visits. We studied patient opinions and preference on virtual versus in-person visits, and the factors influencing such preferences. Methods Telephone surveys, consisting of 11 questions, of patients from 10 neuromuscular centers were completed. Results Five hundred and twenty surveys were completed. Twenty-six percent of respondents preferred virtual visits, while 50% preferred in-person visits. Sixty-four percent reported physical interaction as "very important." For receiving a new diagnosis, 55% preferred in-person vs 35% reporting no preference. Forty percent were concerned about a lack of physical examination vs 20% who were concerned about evaluating vital signs. Eighty four percent reported virtual visits were sufficiently private. Sixty eight percent did not consider expenses a factor in their preference. Although 92% were comfortable with virtual communication technology, 55% preferred video communications, and 19% preferred phone calls. Visit preference was not significantly associated with gender, diagnosis, disease severity, or symptom management. Patients who were concerned about a lack of physical exam or assessment of vitals had significantly higher odds of selecting in-person visits than no preference. Discussion Although neither technology, privacy, nor finance burdened patients in our study, more patients preferred in-person visits than virtual visits and 40% were concerned about a lack of physical examination. Interactions that occur with in-person encounters had high importance for patients, reflecting differences in the perception of the patient-physician relationship between virtual and in-person visits.

Osmotic demyelination syndrome (ODS) was first described by Adams et al. in 1959 as a combination of quadriparesis, pseudobulbar paralysis, and the distinctive myelin loss in the pons, attributable to alcoholism or malnutrition.[1] ODS has since been commonly attributed to rapid correction of chronic hyponatremia. Other reported etiologies include alcohol withdrawal, liver transplantation, hypokalemia, hypernatremia as well as severe hyperglycemia. [2-6] (e1-20) Here, we describe a case of ODS associated with diabetic ketoacidosis (DKA) and review the existing literature on hyperglycemia-related ODS.

INTRODUCTION:Botulinum neurotoxin (BoNT) is one of the most potent and extensively studied neurotoxins with clinical applications across several different medical specialties. This review article explores the latest evidence for therapeutic applications of BoNT in patients receiving critical management in an intensive care unit (ICU).AREAS COVERED:The authors did a literature search in PubMed, Google Scholar, and Texas Medical Center Library database for studies describing the use of BoNT in a critical care setting. They extracted information on study design, patient selection, methodology, and results of relevant studies. Based on initial identification of 85 studies and after conducting screening, the authors identified 61 studies to be included in this review. In an ICU setting, BoNT has been used for several neurological and non-neurological indications. However, the supporting evidence is mostly limited to small observational studies.EXPERT OPINION:The use of BoNT in this setting is largely underutilized due to paucity of well-designed clinical trials and financial barriers. Further research is needed to provide evidence for the safety and efficacy of BoNT and to optimize the dosing and injection techniques for various conditions encountered in this setting.

Cerebral venous thrombosis (CVT) is a rare cause of acute ischemic stroke (AIS). There is no existing literature on the use of recombinant tissue plasminogen activator (rtPA) for venous strokes if they present within the window for thrombolysis. In addition, establishing venous thrombosis as a cause of acute stroke when deciding to administer rtPA can be challenging. We present a case of acute venous stroke who received rtPA when she presented within 4.5- hour window. The report discusses early imaging findings and role of thrombolysis in acute phase of CVT

Background: While the role of telemedicine is well established in certain fields of medicine, its role in disciplines like Neuromuscular medicine is not clear. COVID 19 pandemic compelled the medical community to utilize telemedicine and policies were rapidly changed to continue patient care during the pandemic. However, to guide the future of telemedicine in this field where a physical exam is an integral part of the visit, it is imperative to get a physician's opinion on this matter. We designed this study to assess the opinion of neuromuscular physicians about telemedicine, their preference, and factors influencing their decision. Methods: We used an online form composed of eleven questions to survey 94 neuromuscular specialists across the USA and Canada during September 2020. Results: 90.43% of participating neuromuscular specialists preferred physical visits with new patients versus 44.68% preferred physical visits with follow-up patients. The majority thought that telemedicine reduces revenue (58.51%), quality of service (57.45%), and quality time spent with patients (62.77%). Nevertheless, most surveyed physicians agreed that telemedicine is time-efficient (84.04%), improves patient compliance (70.21%), and will be a long-term solution in clinical practice (67.02%). Finally, 58.51% revealed that telemedicine does not affect workload. Conclusion: Neuromuscular specialists preferred seeing new patients and revealing a new diagnosis to the patient in physical visits, but they also considered telemedicine a long-term method that would continue to increase in the post-pandemic future, emphasizing the need to address their concerns to facilitate telemedicine.

In this era of rapidly changing practice and adoption of tele-neurology in clinical practice due to COVID-19 pandemic, we looked at the physician and patient preference for in-person vs virtual visits to guide clinical decisions about using telemedicine after the crisis is over Data collected from 520 patient surveys revealed that 50% preferred in-person visits and 26% preferred virtual visits Sixty-four percent reported physical face-to-face interaction as very important For receiving a new diagnosis, 55% preferred in-person Forty percent were worried about not being physically examined Eightyfour percent believed virtual visits were sufficiently private Sixty-eight percent did not consider expenses a factor in their decision While 92% were comfortable with using technology, 55% preferred video communications, and 19% preferred phone calls The visit preference was not significantly associated with gender, diagnosis, disease severity, and symptom management Ninety-four neuromuscular specialists across the USA and Canada were phone surveyed in September 2020 90 43% preferred physical visits when seeing new patients while 45% chose virtual visits for follow-ups The majority thought that telemedicine reduces revenue (58 51%), quality of service (57 45%), and quality time spent with patients (62 77%) Nevertheless, most surveyed physicians agreed that telemedicine is time-efficient (84 04%), improves patient compliance (70 21%), and will be a long-term solution in clinical practice (67 02%) Fifty-eight percent revealed that telemedicine does not affect workload The majority of neuromuscular physicians and patients preferred in-person visits for first interaction Initial visit mandates physical exam that is key for diagnosis, but from patient perspective the significance of face-to-face interaction and non-verbal communication was higher The importance of telemedicine for follow up visits can improve compliance, and may be beneficial for social and economic reasons The prospect of improving the quality of care during a virtual interaction is an important factor to consider if we intend to increase satisfaction in the future

BACKGROUND:First-pass efficacy (FPE) is an established marker of technical and clinical efficacy among mechanical thrombectomy (MT) techniques. It is unclear what the optimal approach is in achieving FPE. We present a single-center experience comparing rates of FPE among 2 MT techniques and evaluate the potential predictors of FPE among other outcomes. METHODS:A single-center retrospective analysis was carried out of patients with consecutive large-vessel occlusion strokes (LVOS) of anterior circulation from September 2015 to April 2019 who underwent MT and for whom data were available on the status of FPE. Four MT techniques were identified: ADAPT (a direct first-pass aspiration), SrADAPT (stent retriever with aspiration), SRBG (stent retriever with balloon guide catheter), and STRAP (stent retriever-aspiration and proximal flow arrest). The primary outcome was FPE and secondary outcomes included the rate of successful reperfusion. RESULTS:Among 226 patients with LVOS of the anterior circulation who underwent MT, data were available for 164 on FPE for the 4 MT techniques. SRBG was the most prevalent technique. No significant difference was found in rates of FPE among the 4 MT techniques (P = 0.332). No independent predictors of FPE were identified on multivariable analysis. STRAP had the highest rate of successful reperfusion compared with the other techniques (P = 0.049) and was the only independent predictor of that outcome (P = 0.027). CONCLUSIONS:Among patients with LVOS of the anterior circulation, the rate of FPE did not differ among the 4 MT techniques. There were no predictors of FPE among the studied variables. STRAP was the only predictor of successful reperfusion.