Yesterday, I saw a young boy with rabies following a stray dog bite. Every time I see a patient like this, I am reminded that rabies is probably the only neurological disease where the most important treatment should have happened weeks before the patient reached the neurologist. By the time we see hydrophobia, aerophobia, autonomic storms, agitation, dysphagia or paralysis, the virus has already travelled silently through the peripheral nerves into the brain. At that stage, despite all advances in critical care, our options become extremely limited. A few practical points that every clinician and every family should know: • The first treatment is not the anti-rabies vaccine. It is immediate washing of the wound with soap and running water for at least 15 minutes. This simple step can significantly reduce the viral load. • Never judge the severity of a bite by the size of the wound. A tiny puncture over the finger or face may be more dangerous than a large wound over the leg because these areas are densely supplied with nerves and are closer to the brain. • Every Category III exposure should make you ask one important question. Was rabies immunoglobulin infiltrated into and around the wound? Injecting it only into the arm or gluteal region misses its main purpose, which is to neutralize the virus where it entered. • Vaccine schedules save lives only when completed correctly. Missing doses or delaying treatment can have devastating consequences. • If a patient develops burning or tingling at the old bite site, difficulty swallowing, fear of water, fear of air drafts, unexplained agitation, acute weakness or rapidly progressive encephalitis after an animal bite, rabies should be considered immediately. For the public, one message is enough. Never ignore even a stray dog bite. Never rely on home remedies. Wash the wound immediately, seek medical attention the same day and ask whether rabies vaccine and immunoglobulin are required. Rabies remains one of the deadliest diseases we know, yet it is also one of the most preventable. The tragedy is not that we cannot treat rabies once it reaches the brain. The tragedy is that we often miss the opportunity to stop it before it enters the nerve. #Rabies #Neurology #EmergencyMedicine #DogBite #PublicHealth #NeurocriticalCare #Neurotwitter