Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you manage neuropathic chemotherapy agents in patients with underlying multiple sclerosis?
I would make sure that if they do have B and T cell immunosuppressive effects (I would check their FDA access data records, phase 3 clinical trials, other drug sites that detail their MOA) and I am convinced that my MS drugs (if the patient is on any) are not needed, I would discontinue such therapy...
What are the best treatment options for persistent post-traumatic headaches when first line agents like TCAs have failed?
Would treat post-traumatic headache according to the primary headache disorder phenotype.Post-traumatic headaches statistically most often have a migraine disorder phenotype. So if one does not respond to TCA as a preventative medication then I would consider other migraine disorder preventative med...
How do you approach the diagnosis and treatment of recurrent neurosyphilis in a previously treated patient?
This question is answered by CDC guidelines: https://www.cdc.gov/std/treatment-guidelines/neurosyphilis.htm A patient with neurosyphilis needs to get serial non-treponemal (VDRL/RPR) tests from serum after completion of the 14-day IV penicillin course (3,6,9,12 and 24 months). A 4-fold reduction of ...
How often do you monitor CD-19 counts and immunoglobulin levels in MS patients on B-cell depletion therapy?
This is a very timely question and one that is largely unresolved. There is currently no consensus on whether or how frequently gamma globulin levels should be monitored. Similarly, there is no consensus regarding the frequency of CD19 monitoring.Monitoring CD19 counts after rituximab therapy for pa...
In what conditions can you see roving eye movements?
Roving eye movements are seen in comatose patients with intact oculomotor/ brainstem function. These movements can be conjugate or dysconjugate with no pathological significance between the two. Movements are usually horizontal, but vertical eye movements can also occur. Their presence rules out psy...
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 ...