Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What is your approach to benign appearing (on MRI) septum pellucidum/intra-ventricular masses?
I typically view "benign-appearing" on MRI as a helpful indicator but one that we usually can't altogether trust in isolation. I would consider size, symptoms, risk of obstruction, and any trajectory of change. I would at least consider cytology and cfDNA from CSF if biopsy is felt infeasible, and p...
How much does platelet mapping or platelet function analysis influence your management, particularly in patients with recurrent ischemic strokes despite being on dual antiplatelet therapy?
P2Y12 or CYP2C19 testing, when available, is a reasonable part of the workup for recurrent strokes on dual antiplatelet. However, it is only one aspect of the workup, with the rest focusing on uncontrolled risk factors and untreated mechanisms like atrial fibrillation, carotid web, thrombophilia, ca...
What are your preferred beta blockers for migraine prevention treatment?
Beta blockers, originally developed for cardiovascular disease, were serendipitously discovered to reduce the frequency and severity of migraine attacks in the late 1960s. They remain the most widely used class of prescription preventive medications for migraine. Among beta-blockers, only propranolo...
Do you give TNK to patients presenting with transient global amnesia like symptoms within 4.5 hours?
This is a very interesting clinical question that does not come up practically very often. There is next to no study data available on the matter, so most of what I will propose here can be classified as an expert take. I think that the most direct, and clinically relevant way of approaching such a ...
How do you determine the time window for which to monitor for cerebral edema development in patients with brain injury?
The type of edema definitely matters. The two big categories of cerebral edema include cytotoxic and vasogenic edema. Cytotoxic results from free water accumulation in dying cells from acute brain injury, while vasogenic edema results in disruption of the blood-brain barrier. The classic teaching is...
How do you approach treatment of a young adult with an intracranial anaplastic ependymoma and a single intradural cervical spine metastasis?
A high-grade tumor, such as anaplastic ependymoma, carries a higher risk of CSF seeding down the neuroaxis than lower grades. Secondary spinal drop metastases are considered a serious but relatively rare complication in this disease. Assuming that the metastasis was detected at the time of diagnosi...
How do you manage and adjust Parkinson’s medication if a patient has worsening orthostatic hypotension while being treated with carbidopa/levodopa?
Levodopa is such an important pillar of Parkinson's therapy that it is often necessary to continue this drug despite the worsening of orthostatic intolerance.This is a step-wise approach (i.e., don't go to step 4 if you haven't addressed step 2): Ensure that the patient is getting symptomatic benefi...
When is air travel safe for patients with recent diagnosis of ischemic stroke?
Air travel on a modern commercial jet includes full pressurization and oxygenation, such that I see minimal or no risk to air travel. Flying on a small, private plane would have higher risk, so I would wait longer for that, perhaps even a month. During helicopter flights for acute stroke patients, o...
What are your top takeaways in Neuro Oncology from ASCO 2025?
Aizer et al., JCO 2025 - A multi-instituitional Brigham Dana-Farber-led trial randomized 196 patients with 5-20 brain metastases to stereotactic radiosurgery (SRS) or hippocampal avoidance whole brain radiotherapy (HA-WBRT). Patients treated on the SRS arm had significantly less symptom burden, wit...
When do you consider repeating an autoimmune encephalopathy work up if initial MRI, LP, and paraneoplastic panel antibodies are non-revealing?
This is highly dependent on the specific clinical scenario and my pre-test probability of autoimmune encephalitis. Tools like APE2 help provide a framework for assessing how likely a positive result on antibody panel at the time of initial presentation. If the initial workup with MRI, basic CSF stud...