Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you counsel B cell-depleted multiple sclerosis patients on the benefits of regular COVID-19 vaccinations?
The fact that B cell-depleted patients render a blunted antibody response is not unexpected, but antibodies do not protect from viral infections - cells do. To measure a proper vaccine response, one wants to test T cells from patients to see if they are able to kill viral infected cells. This is wha...
What primary and secondary stroke prevention strategies do you use for patients with a pulmonary AVM (PAVM)?
This is not a common problem in stroke neurology. I have been involved in this problem for a patient with HHT (also known as Osler-Weber-Rendu syndrome). Sporadic or post-surgical AVMs may also arise but they are uncommon. In general, the treatment in both scenarios (primary and secondary prevention...
What medications are preferred and contraindicated for insomnia in patients with a recent stroke or traumatic brain injury?
In acute brain injury (ABI), which includes stroke and traumatic brain injury the focus is often on neurorehabilitation. The presumption here is that the patient is medically and neurologically stable. For example, not having a stroke in evolution, uncontrolled gastrointestinal bleeding, or similar....
When do you use greater occipital nerve block to treat acute refractory migraine?
I frequently offer ONBs for patients with acute migraine when they have persistent headache, despite migraine cocktail & other initial ER interventions. Since occipital nerve blocks are safe, effective, and have Level A recommendations from the American Headache Society, I perform them quite frequen...
When would you start antiepileptic drugs in a critically ill patient who develops myoclonic jerks but has not yet had an EEG?
Treatment depends on the setting in which these myoclonic jerks are seen. In a non-cardiac arrest patient, such myoclonic jerks are often due to medications, organ dysfunction (e.g., uremia, etc), electrolyte imbalance, or non-convulsive seizures, etc, and workup for this is recommended with labs, h...
What are your ISC 2026 top takeaways?
The most important presentation was the OCEANIC-STROKE trial showing that asundexian plus antiplatelet therapy was superior to antiplatelet therapy for secondary stroke prevention. The drug will likely be FDA-approved and change clinical practice. The CHOICE-2 trial of adjunctive i.a. thrombolysis a...
When would you consider GLP-1 receptor agonists for IIH in patients at a healthy weight and BMI?
Randomized clinical trial data demonstrate that exenatide (exendin-4), a GLP-1 receptor agonist, reduces ICP in women with active IIH, with reductions of approximately 5–6 cm water of CSF and no serious side effects; this result is both statistically and clinically significant. This pressure-lowerin...
What is your approach towards continuing cancer screening in a young adult with Tif-1+ dermatomyositis, and negative initial CT chest/abd/pelvis?
Young TIF-1 is likely behave as juvenile DM with TIF-1, where the risk of cancer is much lower. I have many young TIF-1 that never developed cancer. I still think that careful ongoing monitoring is needed for 3 years from diagnosis. For cancer risk assessment and management, use the International gu...
How do you approach treatment of 1p19q non-codeleted high grade gliomas?
The question focuses on the management of 1p19q non-codeleted high-grade gliomas, which for all practical purposes translates roughly to the entity that by legacy terminology has been referred to as anaplastic astrocytoma. This question has come into focus with the recent publication of results of t...
What do you recommend as a first-line antidepressant in patients with major depressive disorder and migraines?
In my clinical practice, I have found SNRI medication, particularly extended-release venlafaxine (dosed from 37.5 mg to 225 mg), to be helpful for patients with both comorbidities. Other medication classes I have seen used to good effect include TCAs (amitriptyline, nortriptyline) and some SSRIs (se...