Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Would you recommend temporary EVD or more permanently VPS to lower ICP?
We only place EVDs in patients who meet criteria with a GCS of 8 or less. If they are a GCS 9 or greater, we empirically manage cerebral edema if we think it is present, but do not monitor ICP with invasive devices. With regards to VPS, we never use them acutely to lower ICP. Shunts are only used i...
How do you manage radiation plexopathy?
This is a frustrating problem. I agree that there are no proven treatments for radiation plexopathy. However, chronic radiation injuries appear due at least in part to an ongoing inflammatory process. Interrupting this process with pentoxifylline and Vitamin E has been successful in reversing fibros...
How do you approach the management of interictal discharge burden in patients with generalized epilepsy syndromes (i.e. genetic)?
Assuming the patient has normal cognition, I simply treat clinically to target seizure freedom with minimal side effects.
Do patients with NPH/communicating hydrocephalus always require VPS?
This is a complicated question. Evaluations for NPH include monitoring for neurological improvement following a large-volume lumbar puncture or a lumbar drain trial. At our institution, we prefer a lumbar drain trial as it allows more volume to be removed over time and mimics the placement of a shun...
What do you use to treat cramping in Kennedy's disease?
Trial of low dose testosterone 40mg orally daily as needed is worth to consider to combat symptoms since there is not specific cure. It seems working for paramyotonia congenita symptoms having similar symptoms of muscle cramps, pain and in many cases subjective weakness over years.
Does pregabalin contribute to esophagitis or gastroparesis?
Based on personal experience, no. Regarding gastroparesis, it appears that pregabalin is frequently used for the abdominal pain related to gastroparesis with acceptable results and without worsening of gastric motility: https://www.tandfonline.com/doi/full/10.2147/CEG.S362879
What is your approach to managing a patient with a history of tardive dyskinesia on a VMAT2 inhibitor, presenting with parkinsonism and found to have an abnormal DAT scan?
I have seen multiple experts use both VMAT2 inhibitors and levodopa simultaneously in these instances, though reluctantly so. It depends on the severity of TD and PD (which is obviously exacerbated by VMAT2 inhibitors) and which symptoms are most bothersome for the patient. Some options include: R...
When should headache treatment be escalated to inpatient IV lidocaine?
Overall, there is a lack of data (few studies) supporting the use of IV lidocaine. There are safety concerns, especially in the pediatric population. The other barrier is lack of expertise, most institutions need a sedation/anesthesia team for IV lidocaine administration even if it's done in outpati...
How do you interpret the finding of identical bands in CSF and serum in patients being evaluated for MS?
To show inflammation within the CNS compartment, generally, you need to show bands present in the CSF that are not seen in the serum.
What is your workup for CSF studies when evaluating for possible CNS Lupus?
CSF studies for CNS lupus are most important in ruling out non-lupus CNS problems, e.g. infections and malignancy. So you want to target CSF studies toward the differential diagnosis of the presenting CNS phenotype. Typically these would include cell counts with diff, glucose, total protein, CSF IgG...