Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What management do you recommend in patients with backpack palsy?
Backpack palsy is a well-known brachial plexus injury, often affecting the upper/middle trunks, resulting from carrying heavy loads on the shoulders and upper back. I used to believe that it is typically a stretch injury causing transient neurapraxia (demyelination) with minimal axonal loss and an o...
How would you evaluate and treat a disabling tongue tremor?
This is a very interesting presentation. First, establishing phenomenology is needed. Is this a tremor or does it appear tremulous? Tremor is oscillatory and rhythmic. If these movements do not fit this pattern, consideration of neuromuscular disorders, like myorhythmia, or other movement disorders ...
Do you start aspirin for patients with incidentally found intracranial vertebral stenosis?
I'm not aware of any clinical trial evidence, but in this scenario, I would probably start with baby aspirin.
When do you refer patients diagnosed with Moyamoya disease to neurosurgery?
I almost always refer patients with Moyamoya to neurosurgery. The only treatment for this condition is either direct or indirect bypass surgery. If they have any active symptoms, have an old infarct, or recent stroke visible on scans, surgery is worth considering.
Do you recommend CSF analysis in young patients with imaging findings consistent with progressive supranuclear palsy?
This is a difficult question and I'm not experienced enough to give you a great answer. In the end, it depends on the age of onset (age <50 would give me pause), rate of progression, the inclusion of expected PSP symptomology (supranuclear palsy, akinetic-rigid axial parkinsonism, spontaneous retrop...
Do you see secondary EMG/NCS abnormalities in patients with chronic upper motor neuron dysfunction such as cerebral palsy, myelopathy, or remote stroke?
The short answer is NO. UMN deficits result in low firing rates, leading to fewer activated motor units, but this does not constitute denervation. Nonetheless, the concept of trans-synaptic degeneration has been discussed for over 50 years (I believe Dr. Wilder Penfield, the neurosurgeon from Montre...
How do you counsel patients on migraine "triggers"?
What often triggers headaches or migraines is not just one factor acting alone, but rather a combination of triggers compounding together. Consequently, it's generally more effective and less demanding to prevent triggers from compounding, rather than avoiding them altogether. However, the first ste...