Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your approach to determining eligibility for hospice in persons with Alzheimer's disease?
We strongly recommend early hospice enrollment for patients with dementia as soon as they meet eligibility criteria. In our approach, we carefully evaluate both functional and cognitive decline. One area that is often overlooked, however, is nutrition. When a patient with Alzheimer’s disease begins ...
Should aTTR mutation with bilateral carpal tunnel alone prompt treatment with a gene silencing drug?
Carpal tunnel syndrome does not qualify as a peripheral neuropathy due to TTR amyloid. The amyloid deposition is in the soft and/or connective tissue and not in the nerve. As such, there is no clear indication to treat as much as one might be tempted. Careful follow-up and treatment as soon as neuro...
How do you utilize OCT for the diagnosis and management of IIH?
OCT can be a valuable adjunctive objective tool for diagnosing and monitoring papilledema in IIH. However, when it is used, it should not be used alone. It must be integrated with perimetry and fundus exam/photography. It has important limitations that preclude its use as a standalone modality.Limit...
What is your approach to outpatient antihypertensive therapy after ICH for secondary prevention?
My approach to secondary prevention of ICH depends on the cause.With hypertensive ICH for secondary prevention, the blood pressure goal is less than 130/80 (This is from using the results of the SPS III trial, given the pathological disease mechanisms for both ischemic and hypertensive hemorrhages a...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
What strategies do you find helpful in advanced care planning with patients/families who are very "miracle" centered?
Hope for the miracle yourself! Broaden: “Are there any other things you are hoping for?” Hope for the best, prepare for the worst: “I see how much you want a miracle. I wonder if we can talk about what we should do if this doesn’t happen.” Consider involving a religious leader if relevant.
How do you decide between using nuclear medicine scanning versus computed tomographic angiography (CTA) for ancillary brain death testing?
I would NEVER use CTA as an ancillary test when determining brain death.The American Academy of Neurology guidelines specifically classify CT angiography as an unacceptable ancillary test for brain death determination.The acceptable ancillary tests for adults include digital subtraction angiography ...
How do you manage seemingly treatment-resistant chronic migraine?
First, let's define refractory migraine. The most recent and strict diagnosis that I use was a proposal by the European Headache Federation (EHF):Refractory Migraine Established diagnosis of 1.1 Migraine without aura and/or 1.2 Migraine with aura or 1.3 Chronic migraine according to ICHD-III criter...
What are your top takeaways in Neuro Oncology from ASCO 2026?
The study on TMZ use duration. And the CAR T talk.
When do you add corticosteroids to the treatment of HSV encephalitis?
My practice does not involve adding corticosteroids to confirmed HSV encephalitis unless there is a significant concern for malignant edema and midline shift. We lack large randomized, placebo-controlled trials, therefore their role is uncertain as of yet.