Neurology&nbsp;&nbsp;&nbsp;

What is your strategy for treating headaches in patients with history of brain tumor?

Specifically, headaches thought not to be related to increased ICP.

How do you approach anti-seizure medication management when it was started by another team for a seizure-naive patient before/after craniotomy for a tumor?

Do you refer all patients with new findings of CNS or epidural mets/tumor to ED for evaluation or are there some that can be managed completely outpatient?

E.g., patients with small CNS mets without vasogenic edema or symptoms. Epidural disease without epidural spinal cord compression or asymptomatic low-...

How do you evaluate a patient with MGUS and peripheral neuropathy?

Can you explain when would you consider light chain amyloidosis work up with fat pad biopsy?

When is the best time to try targeted therapy in adult-type diffuse non-IDH glioma?

I have seen targeted therapies used (and studied) more often in the recurrent setting. However, there may also be some rationale for trying BRAF/MEK E...

Is there a role for intravenous temozolomide in place of oral for the 5-day dosing q 28 days after surgery/XRT+Temozolomide for glioblastoma multiforme?

For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?

If so, how long do you continue medication and when do you discontinue? Does treatment with surgical resection versus radiation alone change your mana...

How do you manage glioblastoma presenting with leptomeningeal dissemination?

How do you time CSF analysis for suspected CNS lymphoma in patients who are on steroids?

How do different inflammatory markers like CRP and ferritin contribute differently, if at all, to the monitoring of CART neurotoxicity?

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?

What recommendations would you make for a patient on long-term phenytoin due to epilepsy with a newly diagnosed breast cancer requiring doxorubicin as part of her chemotherapy?

How would you counsel the patient given the drug interactions present?

What approach do you use when treating adult diffuse gliomas with H3-G34 mutations, now classified into their own category under the 2021 glioma guidelines?

Do you treat this similarly to IDH-Wildtype GBM with the STUPP regimen? Is there any role of less-intensive paradigms, such as 59.4 Gy/33 fx?

What is your approach to management of a subtotally resected pineal parenchymal tumor of intermediate differentiation (CNS WHO grade 2)?

Is there a role for adjuvant chemotherapy or radiation?

Do you typically use NOACs or Lovenox in patients with stroke due to hypercoagulability from malignancy?

How do you approach treatment of sub-total resected ZFTA fusion ependymoma after radiation therapy in a young adult?

Do you recommend adjuvant chemotherapy after radiation treatment?

How do you use Boswellia for radiation necrosis?

With the recent publication in IJROBP showing a greater than 50% response rate, have you started integrating this into your practice?

For those rare patients now out 5 years post GBM treatment and continuous Optune, is there a point one would stop Optune?

How would you approach a patient over the age of 40 with a sub-totally resected frontal oligodendroglioma, WHO Grade II, 1p/19q co-deleted, IDH mutant, with imaging concerning for second site in the pontomedullary junction?

In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?

What is the harm of waiting for another recurrence after a second GTR to delay the toxicity of radiation and chemotherapy? The patient is a woman <...

How do you approach the management of a patient with lumbar spinal metastasis with neurologic symptoms but without evidence of spinal cord compression?

In a patient with metastatic cancer to the lumbar spine and epidural disease on CT who presents back pain and leg weakness: Is a whole spine MRI in...

Is there a concern for the potential of future congenital malformations in offspring when preservation of eggs and sperm is done AFTER cyclophosphamide treatment given that it is an alkylating agent?

Is it reasonable to extrapolate data from Glioblastoma and discuss Tumor Treating Fields in patients with Grade 4, IDH Mutant, astrocytomas?

How do you manage immunotherapy-induced myasthenia gravis?

How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?

Would you continue KEYNOTE-522 neoadjuvant therapy? The patient has a PMH of sarcoidosis with no stroke risk factors. No residual deficits.

What criteria do you use to decide whether to start anticonvulsants in patients with brain metastases?

Do all patients with brain metastases get started on anticonvulsants? Do you decide based on extent of edema, tumor size, or something else?&nb...

How do you manage incidentally identified pituitary lesions on brain imaging?

What workup do you typically recommend?

How do you manage IgM related peripheral neuropathy?

Do you utilize rituximab or any other specific management strategies?

What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?

Are there any instances where you would prefer a biosimilar rather than the reference product?

What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?

How would you treat an essential-like tremor secondary to tumor (e.g. glioma)?

Is your approach different than that to a primary essential tremor?

How would you approach grade 2 neurologic toxicity in a patient on daratumumab, dexamethasone, and lenalidomide for relapsed multiple myeloma?

Regimen currently 25 mg lenalidomide D1-21 of D28 day cycles, Daratumumab 16 mg/kg every 2 weeks.

When patients develop headaches from luspatercept, do they tend to improve over time?

How would you approach treatment of a patient with recurrent choroid plexus papilloma with intraventricular dissemination?

History of 4th ventricle choroid plexus papilloma s/p GTR, now with recurrent disease in the 4th ventricle and the left lateral ventricle (7 nodules i...

Is there a role to continue aspirin in patients with myeloproliferative disorders who have never had a thrombotic event that are starting DOAC for stroke prophylaxis with newly diagnosed atrial fibrillation?

How would you manage a new suspected brain metastasis in a patient with a distant cancer history?

Would you consider empiric SRS if biopsy/resection is not feasible? When would you consider liquid biopsy?

What are outpatient strategies to mitigate taxane-induced peripheral neuropathy?

Are there any protocols in place? Aside from telling patients to use ice packs or bags or immerse hands/feet in ice water baths from 15" before to 15"...

How do you approach treatment of a grade 4 IDH-mutant astrocytoma, a diagnosis now distinct from glioblastoma according to the 2021 WHO Classification for CNS Tumors?

Are there any risk factors for IO induced rhabdomyolysis and how do you approach and manage it?

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

6 Answers available

What is your treatment approach for a recurrent brainstem glioma?

What is your preferred dose/fractionation following a previous course of radiotherapy?

What would your next line treatment be for a patient previously treated with repeat resection, craniospinal irradiation, and initial cisplatin/vincristine/CCNU with medulloblastoma?

What would be your next treatment for a young adult patient with medulloblastoma refractory to repeat resection, craniospinal irradiation, and initial...

Is IL-6 inhibition an option in patients who are going to be rechallenged with checkpoint inhibitors after previously developing ICI-mediated temporal arteritis?

Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?

How do you approach DMT choice in a patient with MS with a history of cancer?

Based on this review (Melamed and Lee, PMID 31998289), patients with MS on several DMTs may be at higher risk for certain cancers. How does this play ...

What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

What is your strategy to help prevent paclitaxel-related neuropathy?

Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?

How do you manage AEDs in patients with malignant brain tumors?

Do you ever add prophylactic Keppra (levetiracetam) for glioblastoma patients without a seizure history based on data such as this study (nature.com) ...

What is your surveillance strategy in patients with brain metastases who are getting systemic therapy?

How often are you scanning the brain and what is your trigger to treat?

Do you always initiate hypercoagulable work up in a patient with recurrent stroke?

If so, what would you consider ordering?

How would you approach the treatment of checkpoint-inhibitor-mediated temporal arteritis?

Is there role for IVIG? Would you alter the dose or time course of steroid therapy?

How would you approach protein S deficiency found on hypercoagulability work-up in a patient with a post-operative central retinal vein occlusion?

In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...

What schedule and type of antiemetics do you provide for patients receiving PCV for co-deleted oligodendrogliomas?

How do you choose between adjuvant PCV vs temozolomide in high risk oligodendroglioma with IDH mutation and 1p/19q co deletion?

NCCN lists PCV as category 1 (and now with analysis in Abstract 2002 from ASCO 2019 showing benefit in IDH mutated), and temozolomide as 2B, yet temoz...

How do you manage neuropathic chemotherapy agents in patients with underlying multiple sclerosis?

Are there contraindications to drugs like oxaliplatin or abraxane? Does chronicity or severity of the patient's underlying symptoms play a role in yo...

Is antiplatelet or anticoagulant therapy preferred for the secondary prophylaxis of cryptogenic stroke in a patient with underlying malignancy?

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

What are your recommendations for a patient with metastatic non-mutated lung adenocarcinoma who previously had headaches responsive to prednisone but with negative temporal artery biopsy for GCA?

For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...

What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?

How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?

What is the appropriate workup and treatment for patients with SMART syndrome following radiation for brain tumors?

For stroke-like migraine attacks after radiation therapy (SMART syndrome), does your management of these patient's change with recurrent episodes? How...

What is the best course of action for a patient with isolated carcinomatous meningitis who is responding well to intrathecal methotrexate but now has MRI findings suspicious for methotrexate leukoencephalopathy?

Can intrathecal methotrexate be continued with close neurologic observation vs switch in treatment now due to findings?

Do you ever use bevacizumab in combination with standard radiation and temozolomide in the first-line setting for patients with glioblastoma?

If so, when do you consider this?

How do you modify TNBC neoadjuvant chemotherapy in patients with multiple sclerosis?

Do you recommend work up for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?

Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...

How would you manage adjuvant endocrine therapy for a postmenopausal patient with early stage HR+ breast CA who develops an ischemic CVA on an AI?

Presuming that work-up for cardioembolic sources is negative, how would you proceed?

How do you approach treatment of 1p19q non-codeleted high grade gliomas?

Has the recently published interim analysis of the CATNON trial altered your utilization of temozolomide?Does IDH status change your treatment approac...

Is it ever appropriate to omit temozolomide in unmethylated glioblastoma?

Do you consider the small, but statistically significant, improvement in OS to outweigh the side effects of treatment?

How do you approach treatment of a glioblastoma in pregnancy?

In a healthy patient >65 years of age with glioblastoma multiforme, what is the recommendation for temozolomide when given concurrently with adjuvant radiation therapy?

Length of temozolomide course when given with adjuvant radiotherapy

In women of childbearing age with NMDA encephalitis and normal pelvic imaging, is there a role for oophorectomy for possible microteratoma?

If not, how often do you repeat pelvic imaging?

How do you manage oxaliplatin-induced acute peripheral nerve hyperexcitability?

Patients can develop sensory and motor symptoms such as paresthesias, jaw/facial pain and stiffness, cramping and twitching, ptosis and vision changes...