Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you consider a severe ICA stenosis (70-99% narrowing per NASCET criteria) symptomatic if a lacunar stroke attributable to small vessel disease occurs in the perforating arteries (e.g. lenticulostriate) downstream from the stenosis?
This is a great question and I do not think there’s a definite answer for it. Indeed a small portion of subcortical lacunar infarcts is due to proximal embolism. On the other hand, lacunar infarcts and ECAD share multiple risk factors. Evidence of prior embolic-looking lesions, carotid plaque morpho...
What is the recommended approach for extracranial bleeding after tPA?
I almost never reverse for extracranial bleeding unless life-threatening. It can almost always be treated with tamponade, hemodynamic support, and transfusion.
How long do you wait before foley or IV placement in patients who have recieved TNK or TPA?
If foley is needed, especially if going to IR, etc., we place it before if possible, but often place it during infusion or even after if needed.
How do you manage patients with post spinal tap headaches?
There are two tracks of treatment to consider in these patients. The conservative path would be laying supine as much as possible or bed rest, aggressive hydration including intravenously, and caffeine consumption. This should be the first step and tried for 24 to 48 hours before considering procedu...
What is the normal range of spinal tap opening pressure?
Normal range is variable based upon supine versus sitting up, diurnal variations, etc., but the most important thing is what is considered "Low" and "High". For any patient, despite of age and BMI, supine opening pressure above 250 mm of water is considered high, and <6 mm of water is considered low...
What are some commonly missed diagnoses that should be considered in cases of otherwise seronegative yet steroid-responsive autoimmune encephalitis?
One shouldn't neglect to consider lymphoma as another differential in such cases as there had been reports of lymphoid malignancies presenting in such a manner. Ideally, cytology and flow ctyometry would have been obtained at the initial presentation since steroids may alter a CSF profile which migh...
What is your approach to the management of worsening dystonic spasms that are painful and refractory to standard dystonia medications?
Agree with Dr. @Dr. First Last, my friend. I would also add physical therapy specifically asking for a muscle mobilization therapist within a week after chemodenervation. Physical therapy really helps after treatment or without treatment. Also, set realistic expectations about pain management: remin...
Can Guillain-Barre syndrome present with intact reflexes?
GBS is hallmarked by ascending weakness and loss of reflexes simplistically put, with a mean Nadir of 9 days.Tendon reflex loss occurs early in most (70%) but not all patients, progressive reduction during 1st week with the clinical pattern of distribution were in ankles most frequently lost; biceps...
Would you give TNK or IVT to a patient with proximal occlusion and an NIHSS of 0-3 (non-disabling)?
For non-disabling stroke symptoms with an NIHSS 0-5, current AHA Guidelines recommend against IV thrombolysis. (Technically, TNK has not yet made it into the AHA Guidelines, but that's not the topic here). Of course, what is considered disabling is always a debate, but the PRISMS trial defined it as...
Would you give IV thrombolysis to a patient presenting with acute disabling stroke symptoms after a TAVI procedure?
Maybe. If a stroke occurs after a TAVR, it is usually embolic. Theoretically, these patients might be candidates for intravenous thrombolysis, but there are two important reservations. First, patients usually receive full dose of heparin during the procedure, and are loaded with dual antiplatelets i...