Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Are you offering Lutathera for multiple recurrent meningiomas?
Lutathera is currently only FDA-approved for treating somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, research is ongoing to explore its potential use for meningiomas, as many meningiomas express somatostatin receptors, which could make it a promising...
What is your approach to counseling older patients and their families regarding expected recovery of aphasia following a large hemispheric stroke?
There is no precise answer for this question. Every patient follows their own course after a stroke. The size of the infarct and the age of the patient will affect the prognosis. Older patients and those with larger infarcts tend not to have as much recovery. The improvement of aphasia can proceed o...
Is Migraine with Unilateral Motor Symptoms (MUMS) a diagnostic entity worth considering in patients with migraine and other associated symptoms?
I think it is definitely worth considering. In my experience, the unilateral motor symptoms (especially weakness) do occur in relationship with migraine attacks with a frequency that far exceeds true hemiplegic migraine (HM). Often with a very long duration, often not meeting criteria for HM, and mo...
How do you determine when patients can resume their previous activities after a subdural hemorrhage?
First, it depends on the status of the SDH; if surgically removed or with embolization of the middle meningeal artery, then return to activity can be fairly rapid, over 2-3 weeks if gradually increasing, but if no surgery or intravascular procedure, then I would advise more caution. This would mean ...
When should MOG-Ab be tested in patients with suspected autoimmune encephalitis with seizures and normal MRI?
In someone with suspected autoimmune encephalitis with seizures and a normal MRI (presuming done with gadolinium and the optic nerves are well visualized), I would not obtain MOG. MOG testing would have a very low pretest probability (so low that a positive test might well be a false positive). If o...
Do you typically recommend sleep studies for patients with Parkinsonism?
Not necessarily. If there is concern for sleep apnea (i.e., snoring, etc), then it would be worth doing, as a CPAP can be helpful for sleep quality, but I have found most sleep labs (this includes both community and university-based) are not great at otherwise diagnosing/accounting for other sleep a...
How do you counsel patients interested in primary prevention of MS?
While there is now general consensus regarding the role of EBV infection as a trigger of disease, to date, EBV vaccines are not available and haven't been shown to prevent disease. Similarly, there is evidence of a relationship between low vitamin D and MS, though data related to prenatal supplement...
What is the role of inebilizumab in the maintenance treatment of IgG4-related disease?
Inebilizumab may play an important role in the maintenance treatment of IgG4-related disease (IgG4-RD), particularly in patients at high risk for relapse. These are typically patients with multi-organ involvement and elevated serum IgG4 levels who initially respond well to corticosteroids but tend t...
What are potential pitfalls in the use of OCT to support a diagnosis of multiple sclerosis?
OCT used to support a diagnosis of MS must be used with care and with substantial knowledge of OCT and its artifacts. OCT shows retinal nerve fiber layer and retinal ganglion cell damage. There are no OCT findings specific for multiple sclerosis. Therefore, OCT must be interpreted in concert with an...
How do you decide when to discontinue immunotherapy for primary angiitis of the central nervous system (PACNS)?
I take a multidisciplinary approach with involvement of my neurobiology and rheumatology colleagues for the immunotherapy. PACNS can be relapsing or remitting. So needs close monitoring with radiologic (MRI and MRA high resolution vessel wall imaging or CTA/MRA with CSF studies 6 months and then 1 y...