Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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.
Would you recommend genetic polymorphic testing before the initiation of antiplatelet medication in patients with ICAD?
This is not a bad idea if a rapid test is available. If the patient has clopidogrel resistance, I would treat it with brilinta.
How do you wean patients off cenobamate in the EMU and how long can these patients be off of it before having to restart the two month uptitration?
Our practice includes titration by 50-100mg/day. We then titrate back up 50-100mg/day. We also take into consideration of any history of status or refractory breakthrough seizures. Also, most patients who are on cenobamate are on multiple other ASM so we titrate those first if possible and titrating...
How do you manage a patient with progressive cerebellar ataxia and positive cardiolipin antibodies?
I would be very cautious attributing ataxia to the presence of ACL (even if they were persistent). While an association between ataxia and apl has been described, the differential is extremely broad and should be carefully worked up in conjunction with a neurology team. Some of the more common cause...
What pharmacotherapeutic strategy do you use in catamenial epilepsy to further reduce risk of breakthrough seizures around the time of menses?
Evidence is conflicting and incomplete, but suggests that benzodiazepines may be beneficial. I often prescribe clobazam in the week of menses in those patients who do not want to take the medication continuously all month long. The use of acetazolamide may be beneficial as well in some patients. Alt...
What is the best way to prescribe Dhivy™ (carbidopa/levodopa 25/100mg) as an adjunct medication in the treatment of Parkinson’s Disease?
Patients will very rarely be on these because it's rare for a movement disorders neurologist to prescribe them. As @Dr. First Last seems to be implying, patients may 'present' to movement specialists already on these medications. My humble opinion is these odd dose and pill versions (10/100mg carbid...