Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
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.
When do you consider sciatic nerve imaging in cases of foot drop without clinical or EMG involvement beyond the peroneal nerve without clearly indentified compression site?
I think it would be reasonable to image the sciatic nerve in this scenario. Many sciatic neuropathies, especially those caused by compression or inflammatory (vasculitic) lesions, tend to affect the peroneal division much more than the tibial, therefore clinically mimicking a peroneal neuropathy. Th...
How do you manage patients with good relief but intolerable chest tightness with sumatriptan?
Triptan sensations are described as tightness, often in the chest, which may be accompanied by sensations like burning or tingling. These symptoms are reported in 1-7% of patients compared to 1-2.5% of placebo. They have been investigated with the cause still being unclear, but are not a manifestati...
What workup do you suggest for patients with concern for opsoclonus-myoclonus syndrome?
Opsoclonus-myoclonus syndrome (OMS) is characterized by fast and irregular multidirectional eye movements combined with generalized myoclonus and often ataxia. The common etiologies include paraneoplastic, autoimmune, and infectious/parainfectious causes. The approach in children and adults is diffe...
How do you treat persistent headache after a CVST diagnosis?
Follow the phenotype - usually migraine preventives, nerve blocks work well, or neuroleptics with gabapentin or Lyrica. Can be very difficult to treat.
At what point do you refer patients to neurology for evaluation of tics?
I will only refer to neurology if there are other neurologic signs or other movement issues.
Does a patient’s ability to get risk factors under control influence your recommendation for surgical vs. medical management of asymptomatic carotid disease?
Controlling risk factors is paramount, regardless of medical versus surgical management. For asymptomatic disease, primary prevention is the goal, as opposed to the secondary prevention measures we commonly reference.Since CREST-2 was published in late 2025, there has been a lot of discussion on how...
When have you found the Nidra TOMAC device to be helpful for refractory restless leg syndrome?
I have one patient who found it helpful with breakthrough symptoms in refractory RLS, but was unable to get enough coverage to continue using it.
How do you taper steroids for CAA-ri?
Thank you for the question. I have treated two patients so far for CAA-ri, one biopsy-confirmed. I also reviewed the literature on the entity. An oral steroid taper over several months is recommended to reduce the chances of recurrence. There’s no established standard timeline I have found. Monitori...
How do you approach management of an ICU patient with brief potentially ictal rhythmic discharges (BIRDs) on EEG?
This is a very challenging question, and the clinical importance of BIRDs, besides being associated with an increased frequency of seizures (Yoo et al., PMID 24535702 ), is unclear. I am a neurointensivist, and in general, I do not escalate therapy for intermittent BIRDs unless we identify concomita...