Dr Azrung Fayaz

13/09/2025

No investigation can ever replace a clinical examination.

The cranial nerve examination, though, tends to scare a lot of doctors off.

Here's the best demonstration I have seen (from my virtual mentor, Dr Marti Samuels): https://youtu.be/ONRX9yGLXXM?si=1eQffOvzNqWQiGQL

Worth every second!

Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube.

12/09/2025

We see a lot of CNS infections in our setup. This video provides a quick, high-yield review of everything (although the demographics vary) we should be aware of as treating clinicians.

Hope you find it useful and use it to help your patients:

What are central nervous system (CNS) infections? CNS infections include meningitis, which is when pathogens infect the meningeal layers; encephalitis, when ...

06/09/2025

Question everything. It can save lives.

I recently saw a child with seizures and delirium.

He had been labeled “CP” by a renowned physician.

That label was never questioned.

Everyone assumed his cognition was always impaired.

The team thought this was the best he could ever be.

But a little history changed everything.

He had normal development until age 4.

Later mobility problems were due to Charcot-Marie-Tooth disease—not CP.

This is a problem.

Too often, once a label is given, it stays forever.
In settings with poor documentation, that label becomes the full story.

Imagine if he had gone home labeled just “CP.”
He would have been denied proper care—because nobody thought to question it.

Studies show diagnostic error is common.

Misdiagnosis rates can be as high as 60–70%.

So please:
Question every label.

Don’t accept it blindly.

That label might define—or limit—a patient’s care.

I have issues with “CP” as a term—it’s often over-used or unclear.

That’s a discussion for another day.

But today, I ask you this:

Be responsible before you label anyone.

Because the label you choose can follow them for life.

02/09/2025

In medical school, we were amazed by consultants.

They would walk into the ward.
Glance at a patient.
Call the diagnosis.

Like magic.

But maybe it wasn’t magic.
Maybe it was the brain’s 2 + 2 system at work.
Quick. Pattern-based. Reflexive.

Not the slower 234 × 457 system.
That one needs time. Effort. Careful thought.

Both systems are useful.
But if you lean only on the fast one, you will miss.

Because intuition alone is like throwing darts in the dark.
Sometimes you hit.
Most times you don’t.

Diagnosis is not one-shot.
It’s a process.

And processes need systems.

In neurology, the proven system I use (regardless of patient complaint) is:

Step 1. Localize.

In other words, where is the problem. The more specific you can get with this the better.

For instance, localizing a headache to the head is not enough. Is it the skull, the meninges, parenchyma or something else entirely?

Step 2. Use VITAMINS.

- Vascular

- Infectious

- Traumatic / Toxic

- Autoimmune

- Metabolic

- Immune mediated

- Neoplastic

- pSychogenic

Basically, you're trying to describe the category of disease your patient's complain fall into.

You may end up with something like this...
Vascular headache localizing to the CSF-Meninges Barrier.

Simple. Reliable. Time-tested.

Once you do this, your tests have direction.
You know what to look for on the CT.
Your yield goes up.
Your patients get better care.

Fast thinking may look genius.
But systems flip the light on.
You can see.
You can aim.
You can help.
You owe it to your patient's to turn the lights on.

Please join this group for more: https://whatsapp.com/channel/0029Vb6rW8M4inoro4ba1o2V

28/08/2025

22/08/2025

I still remember this like yesterday.

I was just starting my Neurology residency.

A 24-year-old young man came to the ward in a wheelchair. Before I could talk to him, his attendant pulled me aside: “Doctor, he’s a drug addict. We use together. He likely overdosed. Please don’t tell his family.”

With that frame in mind, I walked up to the patient. His father added: “He had hernia surgery a few days ago. Since then, headache. He's never had a headache before. Today, he seems confused.”

I asked him to stand up and walk.

He looked off.

But in my head I said: “He’s just intoxicated.”

He pointed to his head. “It hurts.”

And I thought: “Of course, you junkie.”

So I gave painkillers and sent him home.

Next day, same patient.

My heart sank.

This time on a stretcher. On oxygen. Unconscious. He had had many seizures overnight. A subsequent CT showed a brain bleed.

The truth: I had missed a dangerous headache.

Today, I would not make this mistake. Because now I use a system. A simple, repeatable system to make sure serious headaches are not missed. I use this, no matter what bias I have.

Always, begin with the basics:
- Airway
- BP
- Pulse
- Oxygen
- Random Blood Sugar

If anything is off → Alarm bells.

Next, I look for anything suggestive of a secondary (dangerous headache). These include [mnemonic: SNOOP]:
- Systemic features like fever or weight loss
- Neurological deficits like objective weakness or confusion (like my patient)
- Out of nowhere i.e. never had a headache before (like my patient)
- Onset age > 40 years
- Papilledema (it's not practical to check everyone's eyes. So simply ask them if they have any acute vision issues).

This sounds good in theory, but in reality...

Patients don’t speak in mnemonics. They tell stories.

If you try to ask them direct, point-blank questions, the quality of information is very low.

You're not getting a diagnosis with low quality information.

So let them speak.

My opening line when I first encounter a patient is simple: “Ji?”

Then silence. Let them talk.

After that, I dig deeper. Here's how [mnemonic: SOCRAAT]:

- Site: Where does it hurt? (ask them to point with hand). Pro tip: It's never the whole head. Push them to localize exactly where it hurts.

- Onset: Since when? How did it start? (the latter of these is my favorite question)

- Character: What type of pain (stabbing, dull, burning)?

- Radiation into the neck or chest?

- Alleviating factors: What makes it better?

- Aggravating factors: What makes it worse?

- Time course: Getting worse, better, or the same?

The process does not end here.

You must do a quick review of systems for symptoms that the patient may have missed.

Ask about:
- Fever, weight loss?
- Vision change or gritty eyes?
- Oral ulcers?
- Chest pain, palpitations?
- Bowel/bladder issues?
- Joint pains, rashes, stiffness?

By this point, you have all the information you need to determine if this is a secondary headache. If so, you'll already have a very good idea which one it is.

Most dangerous secondary headaches fall in 3 groups:
- Vascular (these are sudden onset and maximal in severity from the start)
- Infectious
- Miscellaneous (Ocular or Neoplastic)

[Mnemonic: MiSS GGTT R]

- Meningoencephalitis
- Stroke (ischemic or hemorrhagic, venous or arterial)
- Subarachnoid hemorrhage
- Glaucoma
- Giant cell arteritis
- Trauma
- Tumor
- RCVS

And no — this does not take long. A good, focused history takes only minutes. And can save a life. I feel that it is worth it.

Ask yourself: are you treating every headache the same? Is painkiller and done your default?

If so, you are doing a disservice to your patients and yourself. You have been blessed with the ability to think and help people. Use it!

With our patient flow, it is not practical to document everything we have asked the patient.

But it hardly takes seconds to write: Probable vascular secondary headache. Urgent CT brain.

So please, don't use time as an excuse. People's lives are in your hands (or should I say mind).

P.S. Digging out information is a skill. You'll get better the more you practice with a repeatable system.

💡 If you find value in structured frameworks like these join my WhatsApp channel where I share neurology cases, clinical pearls, and practical approaches every week.

👉 https://whatsapp.com/channel/0029Vb6rW8M4inoro4ba1o2V

Don’t just read cases. Train your clinical mind.

15/07/2025

Migraine – Know the Truth

1 in 7 people has migraine.
But more than half don’t know it.
They think it’s just a normal headache.

That’s why diagnosis is step one.
You must know what’s really going on.

Migraine has many types.
And each one needs a different plan.
Guessing is not the answer.

The good news?
You don’t need to travel.
You don’t need to wait in lines.
You can get help online.
From your home.

Once migraine is treated the right way…
Sleep gets better.
Mood gets better.
Work gets easier.
Life becomes lighter.

It all starts with answers.
Let’s find them.

Dr Azrung Fayaz
Neurologist

17/01/2025

Life-Changing Stroke Advice in Less Than a Minute...

How badly do you want to get better?

This isn’t a trick question—it’s the key to your recovery.

If you’re okay with how things are, you won’t push for change. And that’s fine.

But if you value your independence, your freedom, and yourself, here’s the truth...

You can get better.

👉 Studies show that stroke survivors who commit to daily rehab are 3x more likely to regain independence.

👉 Those who set clear goals and work for them make up to 50% more progress than those who just “go through the motions.”

👉 Recovery is as much about mindset as it is about movement. Research reveals that a positive, determined mindset can speed up progress by as much as 30%.

Are You Ready to Change Your Life?

1️⃣ Picture Your Future: Do you want to dress yourself again? Walk without help? Use your hand to write or cook?

2️⃣ Ask Yourself the Hard Question: Do I want this badly enough to work for it every day?

3️⃣ Start Small: Even 15 minutes a day can create a ripple effect that leads to major gains.

Your recovery depends on how much you value your future self.

If you’re ready to reclaim your life, it’s time to act.

Because the biggest question isn’t can you get better. It’s will you.

P.S. To learn more about how stroke survivors like you have turned their life around, click here: https://strokerecoveryprogram.my.canva.site/

Warmly,
Dr. Azrung Fayaz

15/01/2025

Life-Changing Stroke Advice in Less Than a Minute...

Have you ever thought, “What’s the point of starting now?”

Let me tell you about William...

A year and a half after his stroke, William felt stuck.

👉 His hand was tight as a fist.

👉 His leg wasn’t improving.

👉 He had all but given up.

Then he decided to take a chance and start again.

In just 2 months, everything changed:

✅ He was walking without support.

✅ He was using his hand for purposeful movements.

What made the difference?

He started.

Here's why just getting started matters...

👉 The Brain Never Stops Learning.

Neuroplasticity means your brain can rewire itself, no matter how long it’s been since your stroke.

👉 Every Day Counts.

Research shows that consistent rehab can improve recovery by up to 40%—even years after a stroke.

👉 Momentum Builds Progress.

Starting creates small wins, and small wins lead to big changes.

The Biggest Risk? Doing Nothing.

Waiting doesn’t make things better—it makes them harder.

Muscles weaken.

Joints stiffen.

Confidence fades.

But when you take the first step, even if it’s small, you stop the decline and start moving forward.

P.S. Click here to learn more of William's story: https://strokerecoveryprogram.my.canva.site/

Warmly,
Dr. Azrung Fayaz

Helping Stroke Survivors Get Their Lives Back With Science-Based Practices!

12/01/2025

Life-Changing Stroke Advice in Less Than a Minute...

Is your hand tightly clenched and hard to open after your stroke?

You’re not alone—this is a common and frustrating challenge.

Here’s the good news...

One exercise can help the most: Assisted Finger Stretching.

Here's why it works:

👉 Rewires Your Brain: Stretching sends signals to your brain to reconnect with your hand.

👉 Relaxes Tight Muscles: Studies show regular finger stretches can reduce tightness by up to 30%.

👉 Stops Stiffness: Stretching keeps your fingers and hand from getting stuck in one position.

Here's how to do it:

1️⃣ Get Comfortable: Sit down with your hand resting on your lap or a table.

2️⃣ Start with the Thumb: Use your other hand to gently open your thumb away from your palm. Hold for 5-10 seconds.

3️⃣ Move to Each Finger: Slowly open each finger one at a time. Be gentle—don’t force it.

4️⃣ Do This Daily: Try 3 sets of 5 stretches for each finger.

Here are some bonus tips that can boost your progress:

✅ Warm Up: Use a warm towel or heat pack on your hand for 5 minutes before starting.

✅ Be Consistent: Daily stretching improves results by 40% compared to doing it now and then.

✅ Celebrate Small Wins: Even tiny improvements mean progress.

Each stretch brings you closer to opening your hand and taking back control.

It’s not easy, but it’s worth it.

P.S. Ready to unlock your potential? Click here to learn more: https://strokerecoveryprogram.my.canva.site/

Warmly,
Dr. Azrung Fayaz

11/01/2025

Life-Changing Stroke Advice in Less Than a Minute...

Let’s be honest.

The NHS is overwhelmed.

It’s not their fault, but it means your rehab might be delayed or incomplete.

And here’s the scary truth...

Most stroke survivors know the first year is the most critical time for recovery.

Why?

👉 Studies show up to 70% of brain rewiring happens in the first 12 months.

👉 Survivors who delay rehab lose 20-30% of their potential recovery forever.

Every day you wait, you’re losing valuable time.

But here’s the question...

Are you going to sit back and blame the system?

Or are you going to take control of your life?

Think about it like this:

If your house was on fire, would you wait for the fire brigade to arrive?

No—you’d grab a bucket and start putting out the flames yourself.

Your recovery is no different.

Waiting means more weakness, more frustration, and less independence.

P.S. If you’re ready to take control of your recovery, click here to learn more: https://strokerecoveryprogram.my.canva.site/

Warmly,
Dr. Azrung Fayaz

09/01/2025

Life-Changing Stroke Advice in Less Than a Minute...

Stroke recovery has changed so much in the past 10 years.

Scientists have done thousands of studies and spent millions of pounds.

Why? To find out what really works for stroke survivors.

Here’s what they discovered...

1️⃣ Your Brain Can Heal Itself: It’s called neuroplasticity.

With the right rehab, stroke survivors can get back 30-50% of lost movement—even years later.

2️⃣ Focus Beats Random Exercises: Targeted rehab works 3x better than random routines.

3️⃣ What You Eat Matters: A healthy diet with enough protein and fiber can speed up recovery by 20%.

4️⃣ Right Effort Is Key: Doing rehab at a 5-8 effort level (on a scale of 10) helps the brain rewire faster—without burnout.

Think of it like this...

You have the best tools to build a house.

Premium materials!

Expert plans!

But if you don’t use them, nothing gets built.

It’s the same with your recovery.

The science is clear, but it only works if you use it.

Here’s the sad truth...

Many stroke survivors waste time on advice that doesn’t help.

You have one life.

Why waste it doing the wrong things?

Use the latest science to take back your independence.

P.S. Want to see real results? Click here to learn more: https://strokerecoveryprogram.my.canva.site/

Warmly,
Dr. Azrung Fayaz

Helping Stroke Survivors Get Their Lives Back With Science-Based Practices!