Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your approach to the diagnostic workup of small fiber neuropathy in patients with known rheumatic disease?
Small fiber sensory neuropathy (SFN), in general, including in patients with rheumatic diseases, should be suspected based on symptoms (positive more than negative sensory symptoms) and ideally confirmed by clinical examination showing altered temperature and/or pain/pinprick perception in the limbs...
How do you counsel patients who do you not experience early relief of hemifacial spasm after microvascular decompression surgery?
From a neurology standpoint, I counsel patients (preferably ahead of time) that surgery has a reasonable chance of improving hemifacial spasm but is not always effective. There can also be both early and late (reemergent) persisting spasm. I have treated some patients after MVD with botulinum toxin,...
Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?
I would feel very comfortable bridging with apixaban, given its relatively short half-life and fairly quick absorption. I think it is very similar to bridging with Lovenox. More importantly, it usually takes at least 24 hours until heparin IV gets to therapeutic levels - it is often too high or too ...
What follow-up monitoring would you recommend for an adult with self-resolved idiopathic acute pupil-sparing third nerve palsy?
Pupil-sparing third nerve palsy is a relatively common presentation for neuro-ophthalmologists. They typically resolve completely by 12 weeks, and I will typically follow them until they are fully resolved, watching them once a month. The most common are microvascular and associated with a variety o...
Are there any serum markers that can be used to measure disease response to multiple sclerosis therapies?
sNfL/pNfL (neurofilament chain) is the most validated serum biomarker for MS disease activity and treatment response, but it is still not used as standard-of-care routine monitoring. It has several limitations, including nonspecificity as it can be elevated in cases of recent stroke/TIA, trauma, sei...
What are your ISC 2026 top takeaways?
The most important presentation was the OCEANIC-STROKE trial showing that asundexian plus antiplatelet therapy was superior to antiplatelet therapy for secondary stroke prevention. The drug will likely be FDA-approved and change clinical practice. The CHOICE-2 trial of adjunctive i.a. thrombolysis a...
When should surgical tumor resection be considered in patients with a low-grade glioma?
In adults with low-grade gliomas, there is substantial evidence suggesting that aggressive, early surgical resection improves outcomes and survival (Jakola et al., PMID 23099483). Historically, this has been particularly true for tumors that carry an IDH mutation or 1p/19q codeletion. This survival ...
How do you decide which patients would benefit from ECAP-closed loop spinal cord stimulation?
The EVOKE trial enrolled patients with chronic, intractable back and leg pain refractory to conservative therapy - including both persistent spinal pain syndrome (PSPS) type 1 and 2, with the following eligibility criteria: Overall, back, and leg pain VAS ≥60 mm Oswestry Disability Index 41–80 Stab...
How would you approach the consideration of a levodopa trial in an older adult with a history of schizophrenia, stable on antipsychotic medication, who has changes consistent with drug-induced Parkinsonism vs Parkinson's disease?
The first step is to establish if it is degenerative Parkinsonism, such as Parkinson's disease (presynaptic dopaminergic loss) or drug-induced Parkinsonism DIP (due to postsynaptic dopaminergic blockade). I will order a DaT scan to differentiate between the two. If the DaT scan is abnormal, I will s...
What objective measures do you use to test for gait improvement after large volume LP for NPH treatment?
For objective measures, we use a timed 10-meter walk test before and after the large-volume tap test. It measures walking speed and step count. In addition, we use the Clinical Global Impression Scale of Change (CGI-C) by the clinician and by the patient.