Questions discussed in this category

While it is an excellent score for objectively assessing concerning EEG features, there are pathologies where it can be argued that long-term monitori...

When should we consider getting DaT scan in patient suspecting of Parkinsonism syndrome? 

We often use abdominal binders and compression stockings, in addition to hydration and midodrine/fludricortisone. However, are there more targeted the...

For example, patients with spasticity due to hypoxic or anoxic brain injury.

In patients with hx of metastatic cancer, presenting with unilateral proximal arm weakness. No checkpoint inhibitors use.   Which CSF lab...

How does pravastatin differ in advantage from other high-intensity statins?

Do we prophylactically place patients on anticoagulation after one episode? Besides MRI/MRV brain, are there other diagnostic imaging that should b...

With studies showing rare risk of developing epilepsy after PRES do you just taper medications over the following weeks-months? Any need for outpatien...

Especially forms of non-pharmacologic treatment, such as physical therapy or special devices.

Do you charge for it? Do you bring them in to complete the paperwork? or do you send them to PT for Functional Capacity Evaluation ?

 If not, then what is your preferred treatment and would you integrate SRS into it? 

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

Although probably more familiar to ophthalmologists, orbital apex syndrome refers to the consequence of any kind of swelling or mass effect within the...

Instead of waiting for the antibody test to result, if you have a high suspicion for NMDAR encephalitis, is there a role for giving rituximab alongsid...

Is there a role for using a trial of pyridostigmine as a diagnostic aid in a patient with suspected (but not confirmed) myasthenia gravis?

For patients clinically presenting with Transient Global Amnesia and no other focal neurologic deficits, do you always pursue work up to rule out stro...

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

Which triptans are safer in stroke induced migraines?

What is the cost and accessibility of CYP2C19 gene testing? Does the limited availability of rapid genotyping techniques limit the clinical applicabil...

In patients presenting with likely statin-induced myopathy versus statin-induced autoimmune necrotizing myopathy - how do you approach the decision re...

How do you counsel young adults with antibody-negative necrotizing myopathy on prognosis, risk of recurrence, and long-term monitoring/treatment?

How do you plan to incorporate the results of the CHANCE-2 trial (Wang et al., PMID 34708996) in your own practice?

What is the etiology/pathology for tinnitus in Intracranial hypotension? How often is this symptom encountered in patients with intracranial hypotensi...

Do you perform routine screening for coronary artery disease in aging patients already taking these therapies?

Do you distinguish between primary and secondary prevention? Wilson et al., PMID 31130428 is helpful, but curious how people apply this data in practi...

If patients are asymptomatic, what work up do you typically proceed with?

Do EMG studies such as myoclonus or tremor studies change your management?

For patients who present with elevated myoglobin in the setting of normal creatinine kinase and exercise intolerance, what work up process do you typi...

What are your thoughts on the ethics of inpatient use of sedatives in these patients to help with agitation to “protect themselves from harm and...

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

Which holistic treatments for migraine without aura do you recommend for patients who are refractory to standard treatments? 

Occasionally, patients referred for dedicated epilepsy management for "medication refractory epilepsy" are found to have purely non-epileptic spells. ...

Based on this review (, patients with MS on several DMTs may be at higher risk for certain cancers. How does ...

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

Since these patients or their caregivers may not know the symptoms related to sleep disorders and the negative effects on their already compromised ne...

This question is intended to include consideration of cardiac diagnostic screening, as well as initiation & maintenance of lamotrigine, in epileps...

What effective modalities have you found for acute exacerbations of trigeminal neuralgia including in patients who present to the ED? 

How can one safely taper off and stop clonazepam in a woman of reproductive age with epilepsy who is taking it chronically for epilepsy and is plannin...

While some have the practice of 90 days per SAMMPRIS, the lower rates of ischemic stroke in the medical therapy group were driven by events within the...

If so, what percent likelihood do you quote patients for this risk with SRS, SRT and fully fractionated therapy?

Do you routinely discontinue the device or continue if they are otherwise tolerating the treatment well? 

For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...

How do you decide if and when to send patients with AChR+ ocular myasthenia gravis for thymectomy?

How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...

Should one restart lamotrigine or look for an alternative? If no other alternative available, is slow titration vs regular titration preferred?

Do you wait for a second clinical event or start immunomodulatory therapy right away?

How do you manage botulinum toxin injections in a patient with cervical dystonia after getting implanted with DBS?

Do you order any imaging beforehand? Are there other studies that you order?  

What is your preferred approach to a pregnant patient who is in status migrainosus that is refractory to first line treatments?  

Do you require neurosurgical evaluation first? Do you require any patients to wear a neck brace?  

How do you treat dangerous behavioral disturbances (aggression, nighttime wandering) in patients with dementia with Lewy bodies (DLB)?

In patients with chronic migraine and possible medication overuse headache due to chronic narcotic use, what’s your strategy for those patients?...

If you have significant side effects, GI and/or cardiac with one of the cholinesterase inhibitors, would you try using another medication or would you...

The most frequently taught cause of asterixis is hepatopathy and of course hepatic encephalopathy, and has other close associations (ie, uremia), I ha...

How do you manage freezing of gait in Parkinson disease when dopaminergic therapy worsens the freezing phenomenon?

What are the best options for resistant cases of ET?  Focused ultrasound or DBS?

I teach my students/residents that they should hardly ever get routine X-rays in patients presenting with radicular symptoms. MRI far better for seein...

Specifically, what do you do if there is minimal improvement with IV steroids and/or IVIG?

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...

Is there any benefit to starting hyperosmolar therapy prior to the development of depressed level of consciousness or midline shift?

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

Do you just see if the tremors are more associated with action versus static tremors? What are other clinical characteristics that can be helpful to c...

Is there a clinical scenario in which using the 10mg/100mg Carbidopa/Levodopa formulation is preferred to or more beneficial than using the more commo...

The thought being, if no clearly defined lesion exists on available neuroimaging, how do we balance the benefits, risks, and uncertainty in choosing w...

In patients diagnosed with pseudotumor cerebri, is vaginal delivery safe? How do you manage this condition during the pregnancy?

Are there any specific patient populations that you are no longer routinely recommending to start B-cell depleting medications? For example, are you l...

Based on the results of the recent longitudinal analysis linking EBV infection and MS (Bjornevik et al., PMID 35025605), can negative EBV antibodies (...

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...

By completely unremarkable, I mean zero clinical events AND zero interictal abnormalities despite full withdrawal of medications. Assume, for the sake...

What are some high-yield instances where triphasic waves on electroencephalogram (EEG) are more than just harmless markers of gross toxic-metabolic en...

How do you treat refractory focal status epilepticus in an adult with history of alcoholism and traumatic bilateral subdural hematomas who is failing ...

Additionally, what is the current role for temporal artery ultrasound in workup for GCA?

What is the your preferred loading (and maintenance) dose for use of Perampanel in the treatment of refractory status epilepticus?

Specifically, how do you treat the delayed headache, not the headache that develops during the infusion where pre-hydration and slowing down the rate ...

The question is broad and is meant to include patients who have healthy BMD, osteopenia, and osteoporosis, as well as exposure to first generation AED...

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

Do you biopsy immediately, stop treatment, biopsy at a later time, or depend solely on the data you already have?

Is there any additional benefit to radiation in addition to steroids in a patient who is not a surgical candidate?

Given the bleak prognosis in HD, how do you decide which patients will benefit from DBS to treat the chorea?

In what clinical scenario would you refer a patient for embolization? Are there any contraindications? 

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 long do you wait (from onset of symptoms) to do a EMG/NCS in a patient with GBS?

It seems clear that longer monitoring yields more AF detected. What is less clear to me is whether all ILR-detected AF is relevant and merits anticoag...

Is there is a particular pattern of extraocular motility restriction in Miller Fisher syndrome? 

What is the best way to determine if patients with new PCA territory infarct can drive? Upon discharge from the hospital, do you routinely refer them ...

How would you treat patients with symptoms of AIS who have an allergic reaction to TPA with no evidence of large vessel occlusion on imaging? What nex...

Small study in pediatric PACNS have evaluated this as a potential marker (Cellucci et al., PMID 22740622)

For a relatively young, medically compliant patient with HFrEF (EF<35%) and h/o embolic stroke, what is the consensus of starting AC for secondary ...

How do you manage ADHD in patients with Tourette syndrome in order to prevent exacerbating the tics such as with medications like Aderall?

For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention? POD 5? P...

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

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

In patients undergoing continuous EEG monitoring in the ICU, we often encounter EEG patterns that lie along the inter-ictal continuum (IIC). In such c...

Do you approach things differently if a rare variant like this is suspected? Is the Balo's subtype more similar to RRMS or PPMS?

What factors play into your decision whether to re-treat the brain with craniospinal radiotherapy vs irradiation of the spine only vs other measures (...

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

E.g. The case in question is for a patient planned for thoracic RT for LS-SCLC. Any medications that may help or just give much bigger expansions to c...

When do you favor RT? What is your preferred dose/fractionation?

How does length of time from prior chemoradiotherapy influence your management?

Given the slow recovery of nerve damage, what would you expect to see on a repeat EMG after treatment? Continued denervation or just sequelae of past ...

In a palliative setting, how long would you wait to initiate WBRT?

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