Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
In an older adult hospitalized with recurrent falls, weight loss, without clear injuries, but with an inconsistent or difficult-to-reach caregiver, what findings would make you formally report suspected elder neglect and/or abuse?
I'm so glad that you're thinking about the possibility of abuse/neglect in this scenario! It's important to have it on our differential, or we'll always miss this diagnosis. First, it would be good to see if the patient can explain what is happening and provide contextual information that veers us a...
What is your preferred workup for patients who present with concern for autonomic neuropathy?
When patients report one or more symptoms suggestive of autonomic dysfunction, objective confirmation of impaired autonomic function is required. This may include the standard battery of autonomic tests included in the CASS score (tilt table testing, response of HR and BP to Valsalva maneuver, and ...
For patients with hydrocephalus secondary to leptomeningeal disease, how do you determine what type of shunt device to place?
For my small part, please ask neuro-oncology if they plan to use intrathecal chemo (and need a hybrid with Ommaya).
Which imaging features do you use when considering Normal Pressure Hydrocephalus to decide whether to proceed with large-volume LP or lumbar drain trial?
At our center, we follow the approach of the NPH clinic at the Imperial College Hospital in London.See this excellent review article for further details: Carswell, PMID 36162853.
In advanced Parkinson’s disease, how should clinicians assess symptom management and quality of life when patients are no longer able to communicate themselves?
This is challenging and why palliative care professionals are not familiar with neurodegenerative conditions, questions their efficacy in helping our patients. Using validated tools can help such as the ESAS-rPD. This scale can be used to assess response to interventions. Family members may be able ...
How do you counsel patients with postural orthostatic tachycardia syndrome (POTS) regarding safe and effective exercise regimens?
It depends on where they're starting from. If they're starting from scratch, I give them two recommendations: first is the Children's Hospital of Philadelphia protocol, and if they live in town, I refer them to our PT facility at Vanderbilt (The Dayani Center) to have our PT folks help them get star...
When is air travel safe for patients who have developed an intracranial bleed?
I tried to find evidence-based guidance from the literature, but I found only a few pieces of advice. After ICH, unless it was tiny and of clear cause, I would wait at least 4-6 weeks. After SDH, if neurosurgical drainage was performed, then also at least 6 weeks. After SAH, assuming the causative a...
When do you start anticoagulation in patients with endocarditis and evidence of mycotic aneursym?
True estimates of the risk of anticoagulation in endocarditis is hard to come by, since anticoagulation is not common in practice and likely the risk is dynamic and decreases with antibiotic treatment. If one considers thrombolysis as a guide, the presence of endocarditis appears to increase the ris...
How does lack of success of rituximab treatment affect your decision to trial anti-CD19 therapies like inebilizumab?
I strongly believe that deeper and broader CD19 theraphy such as inebilizumab, works on a key different target: offering better disease control due to its broader B-cell targeting, as in CD19, plasmablasts, than rituximab, which targets CD20 (mature B cells), leading to more broad b cell depletion,...
How do you differentiate between HIV associated neurocognitive disease (HAND) and other causes of neurocognitive impairment?
This is a great question. In the era of test and treat, where many people with HIV have never had significant immunocompromise, cognitive impairment due to HIV itself is now relatively rare. On the other hand, people with HIV experience conditions of aging about 10 years earlier than people without ...