Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you evaluate and treat patients with cerebral edema secondary to hyperammonemia?
The previous answer is a reasonable plan for the raised ICP. We need to remove ammonia - ammonia scavengers or dialysis are reasonable. If not liver cirrhosis, look for urea cycle issues even in adults, old GI surgical procedure that creates blind pouch with bacterial overgrowth, etc as other potent...
When is follow-up imaging warranted in patients with anoxic brain injury?
Acutely, either MRI or CT can be used to assess for cerebral edema and impending herniation. However, MRI is much better to assess for extent of ischemic injury. Imaging can be helpful in prognostication as one part of the puzzle, but not in isolation, and prognostication based on imaging alone is p...
What is your approach for a patient with an acute ischemic stroke caused by an aortic thrombus?
It depends upon the risks, factors, and age of the patients. If they have hypercoagulable states then the patient needs anticoagulation otherwise, aortic atheroma is generally "white" clot which is made up of platelets and cholesterol and hence, treatment would be anti-platelets and cholesterol lowe...
When do you consider middle meningeal artery embolization in patients with recurrent subdural hemorrhages?
I recommend middle meningeal artery embolization in patients with larger subdural hematomas.
In what clinical situations do you treat triphasic waves on EEG?
Triphasic waves is an old term, and does not exist as an entity on its own in the new ACNS 2021 guidelines.The new terminology is "Generalized periodic discharges with triphasic morphology". The new definition puts less emphasis on the morphology of discharge, and more emphasis on periodicity itself...
Do you always perform temporal artery biopsy in patients with positive inflammatory markers and high clinical suspicion of GCA?
As with most clinical scenarios, the short answer is 'it depends'. If a patient has cranial symptoms, elevated inflammatory markers, and suspicion for GCA is high, I do refer for temporal artery biopsy to help confirm the diagnosis. This is in line with guidelines from the American College of Rheuma...
How to you treat pregnant women who develop Bell's Palsy?
Bell's palsy is definitely more common in pregnancy and in the immediate postpartum period. For the most part, treatment is identical to how you would treat a non-pregnant patient (which itself is controversial). Whichever treatment is used, it is important to consider initiating treatment within 3 ...
Is either ESR or CRP more sensitive or specific for the diagnosis of GCA?
I typically obtain both an ESR and a CRP in the workup of new onset or relapsing GCA. The CRP may be slightly more sensitive than the ESR based on Kermani et al., PMID 22119103 which demonstrated a sensitivity of 86.9% and 84.1% respectively for CRP and ESR, for a positive TAB. There is discordance ...
In a patient with suspected Miller Fisher syndrome, would you wait until antibody testing results to start IVIG or treat empirically?
Do not wait to treat. Syndromes on the Guillain-Barré spectrum, including Miller-Fisher, are clinical diagnoses. Miller-Fisher may not always have the triad of external ophthalmoplegia, ataxia, and areflexia at the time of presentation and may have overlap features with some other conditions on the ...
How do you treat post-IVIG headache that is not responsive to Tylenol or NSAIDs?
In my opinion, there is no one simple treatment for such headaches. We try slowing the infusion rate, premedicate with steroids, low dose Lasix, or premedicate with Nurtec. Usually, one of these methods helps minimize or eliminate the headaches.