Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you approach tapering high dose continuous infusions for status epilepticus in patients experiencing serious medication-related toxicity?
The short answer is as quickly as possible. How you do it will somewhat depend on the need for ongoing continuous infusion of a sedative for treatment of status epilepticus. Probably the most severe toxicity syndrome is Propofol-Related Infusion Syndrome (PRIS), which if not recognized early, can le...
What is your approach to patients with diffuse, patchy paresthesias affecting the head, face, lips, and/or tongue?
1.) Are the symptoms episodic (coming and going) or constant? If episodic, the likelihood of sinister neurological disease is very low. 2.) Do the hyperventilation test. If the patient has no paresthesias before the test and the symptoms are reliably reproduced by 8-10 deep breaths/min, diagnosis = ...
When should CT-guided blood patch be considered for patients with spontaneous intracranial hypotension headache?
First of all, I think the epidural blood patch for Spontaneous Intracranial Hypotension (SIH) should always be CT-guided and not XR-guided or "blind", whenever possible. And, while headache is present almost always, and the vast majority of the time the headache is orthostatic, the SIH syndrome is n...
When do you use tirofiban for acute ischemic stroke?
Early tirofiban infusion after IV thrombolysis makes sense for acute strokes due to intracranial stenosis. As an endovascular specialist, I have often seen MCA or basilar occlusions reopen with IV thrombolysis but only to reocclude when there is an underlying severe atherosclerotic lesion. My approa...
How do you handle medication management for patients on immunosuppressive therapy who are lost to follow-up?
I typically require one clinical visit at least once a year at minimum to continue prescribing immunotherapy, with a grace period of a few months. If they are lost to follow-up, I cannot ensure safety or clinical efficacy, nor address symptoms or comorbid conditions that worsen their disease. Our te...
What are your top takeaways from ISC 2025?
We had hoped that medium-sized vessel occlusions (MeVOs) would respond to endovascular thrombectomy (EVT) as do large vessel occlusions (LVOs), but several trials show a lack of benefit of current EVT technology for MeVOs. Patients with MeVOs (and more distal occlusions) remain a target for finding...
Is it safe to use monthly injectable CGRP antagonists with oral gepants in the same patient?
Yes. To my knowledge, there is no data to suggest that it is not. I have routinely used oral gepants as abortive treatment in patients who are on a CGRP monoclonal antibody for prevention.There have been at least 2 retrospective studies looking at the safety and tolerability of using oral gepants in...
When do you consider using stimulants in patients with cognitive impairments secondary to traumatic brain injury?
Perhaps most importantly, prescribing medication to address cognitive difficulties conveys hope to TBI patients that even if they have suffered structural brain damage, they can improve. Though the improvement may be fairly small, it can have important implications for better general functioning. We...
When do you refer a patient with recurrent glioma for reoperation?
This question is a nuanced one that is dependent on many factors. When a patient has a recurrent glioma, the treatment options are generally re-resection, medical therapy (traditional chemotherapy or targeted agents, depending on the tumor), or radiation. Which treatment modality, or combination of ...
When do you select cholinesterase inhibitors vs NMDA-antagonist medications in patients with moderate Alzheimer’s dementia?
Cholinesterase inhibitors should be given to all patients (unless there is a contraindication) with Alzheimer's dementia since this class slows cognitive and functional decline as well as reduces all-cause mortality. Memantine, an NMDA receptor antagonist, is only FDA-approved for moderate to severe...