Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your preferred approach to a pregnant patient in status migrainosus refractory to first line treatments?
I bring these patients in for occipital nerve blocks with only 2% Lidocaine. This is safe in pregnancy and has a high rate of success.
Would you recommend medical therapy for asymptomatic idiopathic intracranial hypertension with completely normal visual field testing?
If this patient has asymptomatic papilledema from idiopathic intracranial hypertension, then I might focus on weight loss first, which can be curative. I would follow her visual fields closely, however, and would have a low threshold to start acetazolamide if any change in her visual fields is noted...
Why do we not typically see features of rhabdomyolysis or acute kidney injury with idiopathic inflammatory myopathies?
Because rhabdomyolysis leading to AKI means acute massive necrosis of a large number of muscle fibers with resulting release of myoglobin In blood and precipitation of myoglobin in renal tubules, leading to tubular necrosis. This acute extensive myonecrosis typically does not occur with IIMs, with t...
What is your approach to the treatment of PML-IRIS in patients with HIV who have progressed to AIDS?
The first question I have is whether the diagnosis is truly PML-IRIS if someone is having a progressive HIV infection. By definition, IRIS suggests there is ongoing immune reconstitution, so the immune status of a patient with HIV infection should be improving, not progressing. If someone has HIV t...
What schedule and type of antiemetics do you provide for patients receiving PCV for co-deleted oligodendrogliomas?
I give 16 mg ondansetron and 20mg dexamethasone one hour prior to CCNU/lomustine on day 1 and then 8mg dex on days 2 and 3. I do always prescribe ondansetron q8h as needed and give them compazine to have as well, as needed, q6h. I've honestly had most patients not need anything further, but if they ...
Would you consider spinal cord biopsy for an intramedullary cord lesion with disabling neurological deficits and no diagnosis despite a comprehensive workup?
I would probably do a literary research, and then ask my neurosurgical colleagues if they have had any experience doing that. If they are unsure, I would use the web to track down centers that have a high workload experience of doing a biopsy and direct the patient to be seen at that center provided...
What is the dose conversion formula from botulinum toxin type B (Myobloc®) to incobotulinum toxin type A (Xeomin®) or onabotulinum toxin type A (Botox®)?
There is not a set formula for converting from one formulation to another. In fact, each manufacturer warns against it. One possible guideline: Xeomin:Botox is 1:1. Dysport:Botox is 2.5-4:1 and Myobloc:Botox is 40-50:1. If I need to switch serotype, I would err on selecting a lower dose to start to ...
What is your approach to a completely resected WHO grade II meningioma?
Any attempt toward a definitive answer to this question will at best be too cursory and at worst will jar Pandora’s box, but let’s give it a shot. How to optimally approach patients following gross total resection (GTR) of a WHO grade 2 meningioma remains sufficiently uncertain that 2 randomized tri...
In what patients would you consider adjunctive IVIG for Sjogren's-related neuropathy?
Would consider IVIG in Sjogren's with disabling neuropathy not responding to other treatments (steroids/DMARDs, mycophenolate), in sensory ataxic neuronopathy/dorsal root ganglionitis, and immune-mediated (CIDP).Co-manage with neuro-immunologist, if an option.Literature is a small case series and ca...
How do you taper off Clonazepam in women with epilepsy who are family planning?
Is she only on clonazepam and how much dose? Is she on additional AEDs and how many? Has she failed other AED and what are the other options I can add simultaneously while tapering off clonazepam? What type of epilepsy patient has? These are some of the considerations to keep in mind before switchi...