Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you consider ambulatory EEG as a reasonable alternative to inpatient video EEG?
There are many reasons to use ambulatory EEG video, as long as it is of good quality: Daily events and no need to reduce ASMs Shorter wait time The patient cannot bring a loved one to the EMU The patient cannot be hospitalized for days The main advantages of the inpatient setting are: The ability to...
What is your approach to management of a subtotally resected pineal parenchymal tumor of intermediate differentiation (CNS WHO grade 2)?
In full disclosure, I have had only one adult patient with PPTID. Although PPTID was first described in 1993, it was not recognized by the WHO until the 2000 classification and represents only 1% of primary central nervous system tumors. Prognosis falls somewhere between that of a pineocytoma and pi...
How do you reconcile the benefits of high glycemic load to slow ALS disease progression with previous data on the increased risk for ALS associated with diabetes mellitus?
The relationship between diabetes and ALS is still controversial and poorly understood. Several recent studies, including observational studies in the general population, and Mendelian randomization studies, indicate that type 2 diabetes is associated with a decreased risk of ALS, especially in olde...
Would you consider starting dual antiplatelet therapy in a patient with evidence of petechial hemorrhage post-stroke secondary to ICAD?
Yes, petechial hemorrhage in a stroke would not change my decision to start a short-term course of dual antiplatelet therapy in a patient with TIA or minor stroke and ICAD.
How often is a contrast-enhanced brain MRI truly normal in the setting of spontaneous intracranial hypotension?
In a paper by D'Antona et al., PMID 33393980:"Of 6878 articles, 144 met the selection criteria and reported on average 53 patients with SIH each (range, 10-568 patients). The most common symptoms were orthostatic headache (92% [95% CI, 87%-96%]), nausea (54% [95% CI, 46%-62%]), and neck pain/stiffne...
How do you manage patients with status dystonicus?
Many times, severe, seemingly uncontrollable generalized dystonia can occur in patients with or without a prior history of dystonia. In cases of severe encephalopathy, often treating the encephalopathy is the best overall approach, with medications specifically targeting the movement disorder used s...
Would you attempt a brain MRI in patients who present to the ER with subacute presentation of obstructive hydrocephalus?
I think an MRI is warranted to characterize the cause of the hydrocephalus in almost all cases, especially in the setting of a mass. The MRI can help identify the nature of the mass and the absolute size, and help with the differential diagnosis. It will also help you identify the mass as a solitary...
What would be the clinical benefit of multiphase CTA over CTP?
Fundamentally, no one has ever formally tested and proven that one imaging modality (or imaging approach) is better than another in any time window, for any kind of stroke, when the test is treatment decision-making. Therefore the brief answer to your question is: we do not know. The imaging approac...
How would you work up and manage an isolated CN3 deficit with anisocoria?
This question proposes an isolated CN 3 deficit, with almost no other clinical information. (Just as an aside, it would be important to note whether there is any evidence of aberrant regeneration of CN 3 and also check to make sure that there is no involvement of CN 4, which would immediately shift ...
Does management of NMDA receptor encephalitis change in a patient with HIV/AIDS?
In a patient who is immunodeficient, one must be mindful of the risk of opportunistic infections from additional immunosuppression. With that being said, I would still proceed with first-line therapy (pulse steroids and oral taper, IVIG) and symptomatic/supportive care with anti-seizure medicines an...