Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you recommend EMG/NCS in all patients with clinical findings of carpal tunnel syndrome?
In my experience as a neurophysiologist, a typical Carpal Tunnel Syndrome (with all the classical signs and symptoms) can be diagnosed with high certainty by examination and history alone. My recommendation would be that when the symptoms are mild and the presentation is typical, conservative treatm...
Would it be prudent to complete long term cardiac monitoring (ie. 30 day) in a patient with a new typical appearing lacunar type thalamic infarct and history of hypertension?
This is a really good question. Until this year, I probably would have said that looking for AF in patients with a clear lacunar stroke is not needed. But the recent results from the STROKE AF trial (Bernstein et al., PMID 34061145.) suggest that long term monitors (implanted monitors, so a little d...
What conditions do you screen for in patients with hyperacusis?
Hyperacusis is a non-specific complaint and can be related to a number of different, unrelated pathologies. Screening for specific conditions is largely dictated by other associated signs and symptoms and whether the hyperacusis is unilateral or bilateral. Common conditions include 7th cranial nerve...
Have you seen patients who develop neuromuscular disorders following COVID-19 vaccination?
I have personally seen and managed post vaccine Bell's palsy and one patient with Brachial neuritis, both with improvement after few months.Mahajan et al., PMID 33890680
What is the negative predictive value of a completely unremarkable EMU admission?
Agree... A "negative" EMU evaluation does not, of course, rule out epilepsy. "Unremarkable" or "inconclusive" means the event in question was not recorded and there were no interictal epileptiform abnormalities. In our own study [Benbadis et al., PMID 15329081], we found that represented 15% of EMU ...
What are the best options for resistant cases of ET?
Depends on what you mean by "resistant". Increasing doses of propranolol and primidone, as tolerated, is the simplest move. Other pharmacologic treatments like Topiramate and Gabapentin are sometimes tried but rarely effective. Simultaneous with this you'll want to refer the patient to OT for assist...
What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?
Immune checkpoint inhibitors (ICIs) can cause myositis (ICI-myositis). Since ICIs can also induce hypothyroidism, myopathy secondary from hypothyroidism can also be associated with ICI therapy. Different from thyroid myopathy, patients with ICI-myositis barely have myoedema or muscle pseudohypertrop...
How do you approach the symptomatic management of Lhermitte's phenomenon in a patient with MS?
In my experience, Lhermitte's phenomenon (signifying a cord lesion) generally resolves with time. If the tingling, vibration, or "electric shocks" are persistent and bothersome, I would consider medications that can be helpful for neuropathic pain, such as SNRIs (e.g., duloxetine or venlafaxine) or ...
How do you approach the symptomatic management of central vertigo in a patient with minimal improvement on (or contraindication to) meclizine?
Central vertigo is a difficult symptom to manage and can be frustrating for the patient (and their doctor). Depending on the etiology, treating the underlying cause would be the best first step (e.g. migraine prophylaxis). However, some causes of vertigo may be intractable or take a long time to rec...
How do you treat lupus-associated small fiber neuropathy?
Treatment of small fiber neuropathy associated with SLE consists mainly of symptomatic treatment for neuropathic pain and, if present, autonomic symptoms. Commonly used treatments for neuropathic pain include topical agents such as lidocaine, tricyclic antidepressants such as amitriptyline or nortri...