Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What are your top takeaways from AAN 2022?
My attendance was somewhat limited due to having a speaking role, but select takeaways are as follows: 1. Neurologists need to be creative and strategic in managing neurologic conditions in athletes. Particularly this is true in terms of medication selection and mitigating side effects that may im...
In what patients would you consider adjunctive IVIG for Sjogren's-related neuropathy?
Would consider IVIG in Sjogren's with disabling neuropathy not responding to other treatments (steroids/DMARDs, mycophenolate), in sensory ataxic neuronopathy/dorsal root ganglionitis, and immune-mediated (CIDP).Co-manage with neuro-immunologist, if an option.Literature is a small case series and ca...
How do you taper off Clonazepam in women with epilepsy who are family planning?
Is she only on clonazepam and how much dose? Is she on additional AEDs and how many? Has she failed other AED and what are the other options I can add simultaneously while tapering off clonazepam? What type of epilepsy patient has? These are some of the considerations to keep in mind before switchi...
How do you approach treating patients with trigeminal trophic syndrome?
Very difficult to treat but I have found some success with compounded topical gabapentin (I use gabapentin, amitriptyline, lidocaine from skinmedicinals) +/- PO neuromodulator drugs (gabapentin, TCA) followed by reconstructive surgery with a flap of innervated skin as a last-line. For an itching ...
Do you discourage patients from skydiving/roller coasters with a Chiari malformation?
No, I don't.
At what point do you recommend muscle biopsy in the workup for myositis?
Muscle biopsy is generally recommended and useful in most cases of suspected inflammatory/immune myopathy; accurate pathologic diagnosis is imperative for prognostication, identification of comorbid conditions (e.g., cancer, interstitial lung disease, arthritis, etc.), and treatment decisions. Histo...
What workup do you recommend for patients with low back pain and imaging concerning for spina bifida occulta?
In cases of suspected spina bifida occulta, imaging of the entire spine and Neurosurgery referral are usually recommended. MRI is generally considered the imaging modality of choice, which can also detect other coexisting abnormalities such as tethered cord, while CT can be helpful in better imaging...
How long after starting anticoagulation would you remove an IVC filter in a patient with a DVT presenting with stroke and PFO which is now closed?
This can be a complex scenario. The first question to ponder: if the patient could receive anticoagulation (a/c), why was the filter placed? Let us assume that there was a short period of time from the initial presentation of stroke, during which anticoagulation was contraindicated and there was a l...
How do you counsel patients on driving who have PNEA?
No law or rule here, so case by case and good old clinical judgment. Event severity, type, frequency, etc.A couple of references:Asadi-Pooya, et al., PMID 32913946Benbadis et al., PMID 10897163
When would you recommend standard of care over hypofractionated treatment in an elderly patient diagnosed with Glioblastoma?
Treatment of patients with newly diagnosed GBM who are >70 years of age is controversial and treatment decisions should be individualized. Some patients who are GREATER THAN 70 years of age are candidates for standard 6-week RT+TMZ and some patients who are LESS THAN 70 years of age may require modi...