Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you recommend tapering IVIG in patients whose inflammatory myositis has achieved remission?
This is a very good question without any right or wrong answer. My practice is to start tapering the IVIG 6 months after the patient has achieved clinical remission. I usually start decreasing the dose of the IVIG, but the other option is to extend the interval between the patient's infusions. The e...
How do you incorporate cell-phone videos when diagnosing seizures vs seizure-like episodes?
I regularly review cell phone videos in clinic if they are available or request them of my patients. A video is often worth more than 1000 words. They can be helpful to diagnose episodes in established patients with new types of events and to better understand the episodes patients new to epilepsy c...
What dose do you provide of folic acid in pregnant patients with epilepsy?
I recommend all people of child-bearing potential take 1mg folic acid. If they are taking a prenatal vitamin, are really opposed to taking another vitamin and are not actively trying to become pregnant, I'm ok with the 800mcg included in most standard PNVs. Once they are trying to conceive, however,...
How do you define impaired distal fusion in patients with ICAD?
Once they're out of the acute phase, I define it clinically, i.e., are they having symptoms, and if so are they triggered (low BP, etc) or untriggered? It's helpful to have a baseline perfusion study for future comparison in case they become symptomatic and you want to triage whether off-label hyper...
Do you typically see peripheral neuropathy in patients with castleman syndrome?
Castleman's is a rare disorder. It has been associated with POEMS in which severe neuropathy is part of the syndrome, but is not as common an association as myeloma. But neurologists only see the patients who have neurologic symptoms. My brief look at review articles on Castleman's suggests that POE...
What treatment do you recommend for patients with meralgia paresthetica?
I recommend the following: Weight loss. Better control of sugar if the patient is diabetic. Avoid wearing tight belts or clothing. Sleep on the other side. Rule out inguinal hernia or focal gynecologic problems. Consider using a Lidocaine patch or, if not covered by insurance, a cream. Nerve blocks...
How do you diagnose and manage patients with hypnagogic shooting headache?
Hypnagogic stabbing headache is not an entity. Hypnic headache is and so is stabbing headache. We diagnose both conditions based on the history. Hypnic headache resembles cluster headache, except that the headaches are bilateral. If they last (significantly) longer than 1-2 hours, the proper diagnos...
Should perfusion imaging be the standard of care in cases of a severe symptomatic intracranial stenosis?
I would say no until we prove that perfusion imaging helps risk stratify patients with symptomatic ICAD and select them for reperfusion therapies.
How can you differentiate perforator disease vs artery-to-artery embolus as a stroke etiology?
The infarct pattern is helpful. Perforator infarcts are deep subcortical infarcts whereas emboli tend to be superficial.
Is perfusion imaging reliable in determining stroke infarct vs. area at risk?
It has not been studied in ICAD. More studies are needed to help elucidate this.