Tobias B Kulik, MD

A Causal Word in a Diagnosis Line Records the Order, Not the Cause

A short read on what a cause written into the diagnosis, "post-vaccination" or "post-viral" Guillain-Barré, actually establishes. A composite of cases I see repeatedly, with no detail drawn from any actual matter. A discharge summary lands on your desk. Under diagnoses it reads

The Note Never Says What the Test Ruled Out

A short read on the sentence that goes missing between a normal test result and a discharge decision. A composite of cases I see repeatedly, with no detail drawn from any actual matter. An emergency department record lands on your desk. A patient arrived with three days of ascending weakness

Half of Adults Aged 44 to 48 Have White Matter Hyperintensities

A short read on what a common brain-imaging finding can establish about a collision, and what it cannot. A composite of cases I see repeatedly, with no detail drawn from any actual matter. Two expert reports land on your desk in one matter, both concerning a 47-year-old

The Current Guideline Has No Door-to-Needle Number

A short read on where stroke time benchmarks actually come from, and what a single late case shows and doesn't show. A composite of cases I see repeatedly, with no detail drawn from any actual matter. An expert report lands on your desk. It records a door-to-

The Risk Was in the Chart Before the Drug Was

A short read on what a bleed after thrombolysis (treatment aimed at dissolving the clot causing a stroke) can honestly be called, and the arithmetic both sides skip. A composite of cases I see repeatedly, with no detail drawn from any actual matter. An expert report lands on your desk.

The Label Has Not Moved Since 1996

A short read on stroke thrombolysis (treatment that dissolves the clot causing the stroke) and the question that decides most opinions written about it. A composite of cases I see repeatedly, with no detail drawn from any actual matter. An expert report lands on your desk. It concerns a patient

Between the MRA and the ED

A short read on adult moyamoya cases and the timeline that tends to decide them. A composite of cases I see repeatedly. A 42-year-old woman presents to an emergency department with a focal seizure and a new headache. Her head CT shows an intraparenchymal hemorrhage (bleeding directly into

The Chart Decides a Missed-Bleed Case Before the Scan Does

A short read on what a defensible review of a missed subarachnoid hemorrhage case examines, and why it starts with the history. A composite of cases I see repeatedly, with no detail drawn from any actual matter. A 38-year-old woman presents to a community emergency department with a

Reading the hours before the code

A short read on why HIBI cases turn on two reconstructed timelines, and what each one tends to carry. A 54-year-old man is post-operative day two from elective abdominal surgery, on a telemetry-monitored ward (continuous heart-rhythm and vital-sign monitoring). Nursing documents a respiratory rate