Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How, if at all, do you anticipate incorporating Pixclara PET into the evaluation of suspected recurrent or progressive glioma after treatment?
In pediatric high-grade glioma, I think there's an opportunity to use it selectively when conventional MRI leaves uncertainty between true progression and treatment-related change (pseudoprogression), rather than as part of routine surveillance. The clearest need is in diffuse midline glioma after r...
In patients with suspected reversible cerebral vasoconstriction syndrome (RCVS), is there a role for preventative CCB if the headache has resolved/now asymptomatic?
A number of these patients experience a dull, lingering headache, and I typically maintain them on verapamil, with or without magnesium, until their headache subsides. Afterward, I gradually taper off the medication over 7-10 days. I don't use it as a preventative measure as long as the patient is s...
What is your treatment approach to functional cervical dystonia?
If I am confident that the diagnosis is correct, I generally would treat functional cervical dystonia the same way as any other functional disorder. This includes evaluation of high-risk mental health factors and ideally referral to mental health treatment. In some individuals, functional disorders ...
How do you decide when to resume aspirin after stroke due to septic emboli with hemorrhagic conversion?
I look at multiple factors, including the size and type of the hemorrhagic conversion, septic emboli elsewhere in the brain with associated blood products, MRI, mycotic aneurysms with subarachnoid blood products, and the indication for aspirin. If the patient is at high heart risk because they had a...
How do you manage glioblastoma presenting with leptomeningeal dissemination?
Hospice is a very legitimate option. As physicians, we recommend this far too infrequently.
Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (e.g., cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (e.g., neuropathy, palpable purpura, or glomerulonephritis)?
Yes, I would consider early starting biologics for infiltrative EGPA.
What treatments, after appropriate dose reductions/delays, do you offer for patients with oxaliplatin-induced cold allodynia/dysesthesia?
The primary treatments that I use for cold-induced oxaliplatin neurotoxicity are reducing the oxaliplatin dose and limiting the duration of oxaliplatin treatment (usually not more than 16 weeks of oxaliplatin-containing therapy in the initial line of treatment). Medications that are effective for pa...
Do you utilize neurofilament light chain to guide your treatment strategy for multiple sclerosis?
I do not routinely use serum neurofilament light chain levels to guide treatment decisions. The vast majority of my patients with relapsing-remitting MS are already on high-efficacy therapy, so it would not change my DMT management. In patients with progressive disease, the NfL trend over time is on...
How do you decide on the speed and target of blood pressure reduction for spontaneous intracranial hemorrhage?
I think the target and speed of blood pressure reduction in ICH depend on several variables, including initial SBP, clinical stability, hematoma size, and renal function. For patients presenting with SBP >220, I typically aim to lower the pressure to around SBP 160 over the first 12 hours, then grad...
Does anyone utilize P2Y12 assays to determine if clopidogrel may be ineffective when used for DAPT?
Yes, I use P2Y12 assays in two distinct settings. Medical management: If a patient on clopidogrel mono/dual therapy has disease progression with ICAD or experiences a recurrent ischemic event, I obtain a P2Y12 assay to assess responsiveness. This helps guide the decision to switch to ticagrelor and ...