Questions for the Consultant

Joseph I. Sirven, M.D. Dean M. Wingerchuk, M.D., M.Sc., F.R.C.P.(C.)

We are delighted to present another edition of “Questions for the Consultant,” reprising our 2003 theme for Seminars in Neurology. “Curbside” consultations, conducted face-to-face, by telephone, or electronically, are a staple of Mayo Clinic specialty practice. They entail presentation of a focused clinical question (within the categories of diagnosis, therapy, prognosis, and causation/harm) and receipt of a concise, actionable answer, often at or near the point of care. Successful encounters add value and efficiency to an initial diagnostic or management plan. We have observed that such consultations usually encompass topics that are timely, controversial, and have incomplete or conflicting evidence available to support specific clinical practices.

Our approach was straightforward: we asked colleagues to select a topic or theme for which they were frequently “curbsided” and to present a representative patient vignette. The clinical case provided the springboard for common, contemporary, controversial, or otherwise interesting questions to be addressed in the paper. We encouraged the integration of the best available evidence; indeed, the first paper in the series describes the rationale and practice of evidence-based neurological care, its potential integration into training programs and clinical practice, and its bright future. However, we also sought to highlight particularly challenging areas of neurological practice in which experienced judgment outpace currently available evidence-the ongoing balance of medicine as scientific art.

We gratefully acknowledge the contributions of many busy individuals toward this collective effort. We thank Dr. Karen Roos for her ardent support of the series format and the opportunity to produce a sequel. We are indebted to our Mayo Clinic co-authors, whose collegiality, friendship, and steadfast focus on high-quality patient care make this volume possible: Drs. Maria Aguilar (Intracerebral Hemorrhage); Maria Alvarez (Parkinson's Disease and Other Parkinsonian Disorders); Brian Chong (Endovascular Surgical Neuroradiology); Bart Demaerschalk (MERITs of Evidence-Based Clinical Practice Neurology and Intracerebral Hemorrhage); Joseph Drazkowski (Brain Death Determination); Erika Driver-Dunckley (Parkinson's Disease and Other Parkinsonian Disorders); Gerry Evidente (Parkinson's Disease and Other Parkinsonian Disorders); Brent Goodman (Small Fiber Peripheral Neuropathy and Orthostatic Intolerance); Mark Lyons (Brain Tumors); Katherine Noe (Women's Issues in Epilepsy); Mark Ross (IVIG Therapy for Neuromuscular Disease); Sujay Vora (Brain Tumors); and Bryan Woodruff (Rapidly Progressive Dementias). We trust that you will profit from their efforts.