The library

The case library

Every case is a patient, a set of examination findings, and a sequence of decisions you commit to before the reveal. Each page states its evidence and its sources.

Stroke

Acute

The flaccid arm — protecting the shoulder71M, day 4, NIHSS 14Tier 2
The dose question — acute L MCA after thrombolysis67M, day 2, NIHSS 12Tier 2
The small stroke that walks — lacunar pure motor58F, day 2, NIHSS 4Tier 1
The severe stroke — basilar artery, day 372M, day 3, NIHSS 24Tier 4
The wobble is not vestibular — cerebellar hemorrhage64F, day 4, NIHSS 8Tier 3
The swallow comes first — lateral medulla61M, day 2, NIHSS 6Tier 3

Subacute

The first stand — subacute hemiparesis62F, day 16, NIHSS 6Tier 1
The left side of the world — neglect after right stroke68F, day 11, NIHSS 8Tier 3
The wide gait — cerebellar ataxia55M, day 8, NIHSS 4Tier 3
Walking is trained by walking — subacute gait dose70M, day 9, NIHSS 7Tier 1
The tight arm is not a stretching problem — early spasticity55F, day 12, NIHSS 9Tier 2
The words are the therapy — expressive aphasia63M, day 10, NIHSS 8Tier 2
The left side of the world is missing — unilateral neglect71M, day 8, NIHSS 11Tier 3
Going home early is a treatment — early supported discharge69F, day 12, NIHSS 8Tier 2

Chronic

Eight months out — the plateau that isn’t60F, day 240, NIHSS 4Tier 4
Community Reintegration at Six Months63M, day 180, NIHSS 6Tier 3
Caregiver Training at Four Months74F, day 120, NIHSS 7Tier 3
Falls Prevention at Seven Months79F, day 210, NIHSS 3Tier 3
Long-Term Botulinum Toxin Cycle at Nine Months58M, day 270, NIHSS 5Tier 3
Aerobic Fitness After Stroke at Five Months66F, day 150, NIHSS 2Tier 3

Traumatic brain injury

Acute

The monitored brain — severe TBI in the ICU24M, day 3, GCS 8Tier 4
The missing bone flap — mobilizing a trephined skull56M, day 6, GCS 7Tier 3
The storm — paroxysmal sympathetic hyperactivity31M, day 5, GCS 5Tier 4

Subacute

Rancho Level IV — the agitated week45F, day 10, GCS 10Tier 3
Day 14 of a concussion — rest is not the plan19M, day 14, GCS 15Tier 1
The schoolchild — twenty minutes at a time10F, day 21, GCS 12Tier 2
Dizzy in the supermarket aisle28F, day 42, GCS 14Tier 2

Chronic

Eight months out — the calendar he keeps missing34M, day 240, GCS 13Tier 3
The caregiver’s back — transfers at month four67M, day 120, GCS 6Tier 2
Four months of concussion — the woman who cannot work42F, day 120, GCS 15Tier 2

Parkinson’s disease

Early

Sixty days in — the first prescription is exercise58M, UPDRS-III 18Tier 1
The pot on the stove — cognition enters the plan64F, UPDRS-III 24Tier 2
Not Parkinson’s — the referral that argues back72M, UPDRS-III 41Tier 3

Moderate

The freezing doorway — cueing, not a cane67F, UPDRS-III 34Tier 2
The backward faller — the pull test and the next fall71M, UPDRS-III 38Tier 2
The dyskinetic hour — exercise against the diary69M, UPDRS-III 36Tier 3
The runner who wants the pool65M, UPDRS-III 33Tier 2

Advanced

Three weeks after DBS — exercise in the “on” window62M, UPDRS-III 26Tier 3
The bent spine — camptocormia and the honest ceiling74M, UPDRS-III 58Tier 4
H&Y V — maintenance is not giving up78F, UPDRS-III 66Tier 4

Balance & falls

Acute

Four hours of vertigo — triage before treatment68M, day 0Tier 3

Subacute

The spinning bed — posterior canal BPPV, right ear55F, day 12, DHI 46Tier 1
Pushing to the paretic side — verticality misperceived71F, day 14, SCP 3Tier 3

Chronic

The grocery-store dizziness — PPPD42F, day 243, DHI 52Tier 2
Three falls in six months — the multi-factorial work-up78M, day 182, TUG 16Tier 4
The wide-based gait — cerebellar ataxia, honestly52F, day 1095, SARA 14Tier 3
Can’t feel the floor — neuropathy, foam and the Romberg64M, day 730, Mini-BESTest 17Tier 2
Worse after the hot shower — Uhthoff’s and the INO38F, day 2190, EDSS 3Tier 2
The walker just in case — fear of falling, deconditioning76F, day 371, FES-I 34Tier 1
Vertigo with a headache — vestibular migraine35F, day 548, DHI 38Tier 2