NANOSNET

I’m from the world of ophthalmology fellowship + NO, so I’m curious about something in the neurology stroke world.

For the patient in the appropriate age group with new neurological symptoms, both presenting in the clinic or ER, such as diplopia and/or blurrier vision, is it advisable for the ER doctor or neurologist to be spring-loaded to get an ESR and CRP and of course CBC and other items as needed in almost all such cases? I’m having a problem with ERs doing mega-evaluations for stroke but not checking an ESR and CRP at least, and have witnessed some spectacular disasters over the past couple months where the disease is missed. It’s routine for the tests to not be done usually when I order them up they’re OK.

They send them out without the inflammatory marker screening with casual advice to see an “eye doctor”. Probably just a random cluster of these events, but I’m struggling how to help curb the problem. Of course, the best of care would be to summon the on-call ophthalmologists in all such cases, but that’s not always feasible or symptoms have been occurring long enough that it’s a stretch to call it an emergency to that degree anyway. It would be a whole lot better if treatment were started if those tests and symptoms got to the threshold to protect the patient until a biopsy is done and an ophthalmologist is consulted.

Mitch

Original Message:
Sent: 8/28/2025 2:32:00 PM
From: Mitchell Gossman
Subject: Screening for GCA in the stroke evaluation

I’m from the world of ophthalmology fellowship + NO, so I’m curious about something in the neurology stroke world.

For the patient in the appropriate age group with new neurological symptoms, both presenting in the clinic or ER, such as diplopia and/or blurrier vision, is it advisable for the ER doctor or neurologist to be spring-loaded to get an ESR and CRP and of course CBC and other items as needed in almost all such cases? I’m having a problem with ERs doing mega-evaluations for stroke but not checking an ESR and CRP at least, and have witnessed some spectacular disasters over the past couple months where the disease is missed. It’s routine for the tests to not be done usually when I order them up they’re OK.

They send them out without the inflammatory marker screening with casual advice to see an “eye doctor”. Probably just a random cluster of these events, but I’m struggling how to help curb the problem. Of course, the best of care would be to summon the on-call ophthalmologists in all such cases, but that’s not always feasible or symptoms have been occurring long enough that it’s a stretch to call it an emergency to that degree anyway. It would be a whole lot better if treatment were started if those tests and symptoms got to the threshold to protect the patient until a biopsy is done and an ophthalmologist is consulted.

Mitch

Original Message:
Sent: 9/3/2025 2:59:00 PM
From: Robert Egan
Subject: RE: Screening for GCA in the stroke evaluation

Hello,

This is a problem and I would say that as a practicing Vascular Neurologist that I have been guilty of not ordering these simple blood tests when we see a patient come in with atrial fibrillation and an M1 occlusion and the focus is on thrombolysis.  I also see many hospital follow ups where the on call Vascular Neurologist did not order them either.  Perhaps Phil Skidd can weigh in on his experience.

Lawyers also love to call me to be an expert witness in a case where a doctor has missed the case so it is otherwise always on my mind in my clinic patients with new headache.  

Robert

Original Message:
Sent: 8/28/2025 2:32:00 PM
From: Mitchell Gossman
Subject: Screening for GCA in the stroke evaluation

I’m from the world of ophthalmology fellowship + NO, so I’m curious about something in the neurology stroke world.

For the patient in the appropriate age group with new neurological symptoms, both presenting in the clinic or ER, such as diplopia and/or blurrier vision, is it advisable for the ER doctor or neurologist to be spring-loaded to get an ESR and CRP and of course CBC and other items as needed in almost all such cases? I’m having a problem with ERs doing mega-evaluations for stroke but not checking an ESR and CRP at least, and have witnessed some spectacular disasters over the past couple months where the disease is missed. It’s routine for the tests to not be done usually when I order them up they’re OK.

They send them out without the inflammatory marker screening with casual advice to see an “eye doctor”. Probably just a random cluster of these events, but I’m struggling how to help curb the problem. Of course, the best of care would be to summon the on-call ophthalmologists in all such cases, but that’s not always feasible or symptoms have been occurring long enough that it’s a stretch to call it an emergency to that degree anyway. It would be a whole lot better if treatment were started if those tests and symptoms got to the threshold to protect the patient until a biopsy is done and an ophthalmologist is consulted.

Mitch