> Act as a Professor of Neonatology, Pediatric Neurology, and Neonatal Neuroradiology from Harvard/Boston Children's Hospital, University of Toronto SickKids, and UCL Great Ormond Street. I am a DrNB/DM Neonatology resident presenting a real NICU patient during consultant rounds. Case: Term neonate, Day 2 of life Focal clonic seizures involving the left upper limb MRI brain suggests acute neonatal arterial ischemic stroke Initially treated with Levetiracetam (Levipil) Persistent seizures requiring loading dose of Lacosamide I want you to conduct a 60-minute consultant ward round viva exactly as it happens in an academic tertiary NICU. Do NOT simplify answers. Ask one question at a time, wait for my answer, then critique it like an examiner before proceeding. Cover every possible topic. Section 1: Presentation How will you summarize this baby in one minute? Problem representation Differential diagnosis before MRI Seizure semiology Localization of lesion Section 2: Neonatal seizures Ask difficult questions on Classification (ILAE) Electroclinical dissociation Focal clonic vs subtle seizures Why neonatal seizures are usually focal Why ischemic stroke commonly presents with focal seizures Seizure burden Status epilepticus definition in neonates EEG correlation Amplitude-integrated EEG interpretation Continuous EEG monitoring Section 3: Neonatal Arterial Ischemic Stroke Cover Definition Incidence Pathophysiology Vascular anatomy Why MCA is commonly involved Right vs left MCA stroke Cortical vs deep nuclear infarcts Watershed infarction Venous infarction versus arterial infarction Timing of injury Evolution on MRI Mechanism of seizure generation Section 4: Etiology Ask exhaustive questions on maternal, placental, cardiac, thrombotic and neonatal causes. Include: Congenital heart disease PFO Birth trauma Placental thrombus Chorioamnionitis Maternal thrombophilia Neonatal thrombophilia Polycythemia Dehydration Sepsis ECMO Catheter-associated thrombosis Section 5: Imaging Ask consultant-level questions regarding MRI sequences DWI ADC T1 T2 FLAIR SWI MR angiography MR venography Diffusion restriction ADC pseudonormalization Why CT may be normal initially Evolution of imaging over time Section 6: Stroke Workup Ask exactly which investigations should be done and why. Include: Echocardiography ECG Placental histopathology Placental culture CBC Coagulation profile Protein C Protein S Antithrombin III Factor V Leiden Prothrombin mutation Homocysteine Antiphospholipid antibodies Lupus anticoagulant MTHFR D-dimer Fibrinogen TORCH indications Blood culture Ask which investigations are evidence-based and which are not routinely recommended. Section 7: Management Ask difficult consultant questions regarding Stabilization Airway Glucose Calcium Sodium Blood pressure targets Temperature Oxygen targets Fluids Nutrition Neuroprotection ICP monitoring Section 8: Antiseizure medications Discuss in depth Phenobarbitone Levetiracetam Phenytoin Lacosamide Midazolam Lidocaine Bumetanide (research) Ask Mechanism Neonatal pharmacokinetics Dose Adverse effects Evidence Comparative trials Why levetiracetam may fail Evidence supporting lacosamide in neonates Maximum dose Maintenance dose ECG monitoring PR interval prolongation Drug interactions Section 9: Antithrombotic therapy Ask Why aspirin is usually not used When aspirin is indicated When LMWH is indicated When anticoagulation is contraindicated Current AHA/AAP recommendations Section 10: Prognosis Ask about Risk of epilepsy Hemiplegic cerebral palsy Language impairment Cognitive outcome Behavioural outcome Autism ADHD Developmental surveillance Repeat MRI Repeat EEG Section 11: Counselling Simulate parents asking: Will my baby walk? Will seizures recur? Will my baby need medicines lifelong? Can this happen again? Future pregnancy risk? Vaccination Physiotherapy Early intervention Section 12: Evidence-based medicine Ask landmark trial questions from ILAE Neonatal Seizure Guidelines WHO AAP AHA Pediatric Stroke Guidelines Canadian Pediatric Stroke Consortium International Pediatric Stroke Study NeoLEV2 NEOLEV Recent systematic reviews (2023–2026) Section 13: Rapid-fire viva Ask 50 one-line consultant questions such as: Why left hand seizure localizes to the right hemisphere? Why DWI becomes positive first? What is ADC pseudonormalization? Why are neonatal strokes usually unilateral? Why does reperfusion injury occur? Which artery supplies the precentral gyrus? Which cortical area produces hand seizures? Why does neonatal cortex generate seizures easily? Which metabolic disorders mimic stroke? When would you suspect cerebral sinovenous thrombosis instead? At the end, give me: 1. Ideal consultant answers 2. Common mistakes residents make 3. High-yield viva pearls 4. Recent guideline updates 5. Ten "consultant favourite" questions that are almost always asked in M/DrNB Neonatology rounds. This prompt will generate a comprehensive, fellowship-level viva tailored to your neonatal arterial ischemic stroke case and closely mirrors the questioning style in academic NICU rounds.

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Do one thing , give me everything with answer at the same time . It will be helpful