Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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...
When is the earliest you escalate treatment for prolonged migraine attacks to parenteral or emergency-level care?
After about 36 hours of status migrainosus.
In patients with suspected RCVS, is there a role for preventative CCB if headache has resolved/now asymptomatic?
In short, the use of CCBs in RCVS is only for the prevention of thunderclap headache (TCH) recurrence. Since their purpose is to prevent TCH recurrence, they are often used when the patient is asymptomatic as well (i.e., even after the index TCH has resolved). They do have no impact on eventual clin...
When do you check thoracic paraspinals on needle EMG in suspected myopathy or myositis?
The need to sample the paraspinal muscles (especially thoracic) in suspected myopathy is diminishing with more sophisticated genetic testing and better antibody testing for inflammatory myopathies. The most common disorder that people learn to remember to sample the paraspinal muscles in Pompe disea...
What objective tools do you use to help determine if a patient is too high risk for anticoagulation to prevent stroke or DVT?
There are a number of risk scores, like HAS-BLED, that can be used, but I continue to use clinical judgment and shared decision-making. The excellent risk profile of NOACs and the availability of LAAO mean that I can usually come up with a solution for almost every patient that will protect them fro...
How to approach reversal of TNK in hemorrhagic conversion of ischemic stroke?
There is no specific "reversal agent" for tenecteplase. Once administered, the thrombolytic effect will persist until the drug is fully metabolized and any residual plasmin has been cleared by alpha-2-antiplasmin. So, perhaps the first question is what can you do if there is an acute bleeding event ...
What do you do as part of a baseline neurologic exam pre-CAR-T therapy in addition to the ICE score?
I treat pediatric patients, and we do a baseline routine neurological exam before CAR-T, nothing else specific.
Under what circumstances do you recommend POCUS guidance for lumbar puncture?
If the circumstances allow for it, I would use ultrasound for guidance for LP every time a LP is performed. This allows for continued practice in identification of the landmarks and improves accuracy in POCUS when it's truly needed, as in obese patients, where landmarks are difficult to palpate. Got...
How do you manage Moya-Moya disease medically for patients that are unable to receive EC-IC bypass?
It depends on the cause. Usually for patients either moya moya disease (in contrast to moya moya syndrome where symptomatic patients would benefit from EDAS or surgical management ) due to atherosclerosis or radiation induced if someone has continued ischemic events or silent infarcts on aspirin mon...
What types of cardiac conduction abnormalities would lead you to avoid using tricyclic antidepressants?
I wouldn’t say it is a definite contraindication. But, I would want to be sure it is a longstanding patient and they are seeing a cardiologist regularly. Then, if the QTc were within reason, I would consider it; but it wouldn’t be high on my list of options.