Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you counsel glioblastoma multiforme patients on which types of clinical trials to pursue?
This is a great question! In general, I think that a clinical trial gives someone access to promising therapies (and of course glioblastoma is an aggressive tumor for which we have no cure), but enrolling in one may not feel like the right decision for all patients (for a variety of reasons). I thin...
What is your approach to seronegative presumed pediatric autoimmune encephalitis?
My approach is to prove that the patient has that condition through objective testing (labs, imaging, tissue sampling) instead of having a "presumed" diagnosis as I do not treat patients based on presumptions...
How do you treat rotational vertebral artery syndrome?
I usually take a multidisciplinary approach to treating these patients. I start the patient on an antithrombotic [at least antiplatelet and if any thrombus due to stasis (or significantly slow flow in those who have had a stroke due to thromboembolism from the area of stasis specifically) then antic...
In what circumstances would you consider use of IDH inhibitors in high-grade astrocytomas?
Please forgive me for the length and directness of my response, but I believe it is important to first go over the INDIGO trial and explain why, in my opinion, it was a highly questionable study, with multiple significant methodological flaws and dubious evidence of Vorasidenib's efficacy.INDIGO tri...
Are you offering Lutathera for multiple recurrent meningiomas?
Lutathera is currently only FDA-approved for treating somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, research is ongoing to explore its potential use for meningiomas, as many meningiomas express somatostatin receptors, which could make it a promising...
What is your approach to counseling older patients and their families regarding expected recovery of aphasia following a large hemispheric stroke?
There is no precise answer for this question. Every patient follows their own course after a stroke. The size of the infarct and the age of the patient will affect the prognosis. Older patients and those with larger infarcts tend not to have as much recovery. The improvement of aphasia can proceed o...
How do you determine when patients can resume their previous activities after a subdural hemorrhage?
First, it depends on the status of the SDH; if surgically removed or with embolization of the middle meningeal artery, then return to activity can be fairly rapid, over 2-3 weeks if gradually increasing, but if no surgery or intravascular procedure, then I would advise more caution. This would mean ...
When should MOG-Ab be tested in patients with suspected autoimmune encephalitis with seizures and normal MRI?
In someone with suspected autoimmune encephalitis with seizures and a normal MRI (presuming done with gadolinium and the optic nerves are well visualized), I would not obtain MOG. MOG testing would have a very low pretest probability (so low that a positive test might well be a false positive). If o...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
In residency, we had to get patient permission to videotape sessions and allow our supervisors to watch sessions from behind a one-way mirror. If I were to use a scribe, especially an AI scribe, or if I were audio or video taping the sessions, I would definitely want to get a patient’s approval. I d...
Do you typically recommend sleep studies for patients with Parkinsonism?
Not necessarily. If there is concern for sleep apnea (i.e., snoring, etc), then it would be worth doing, as a CPAP can be helpful for sleep quality, but I have found most sleep labs (this includes both community and university-based) are not great at otherwise diagnosing/accounting for other sleep a...