Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you approach the treatment of idiopathic myorhythmia?
Idiopathic myorhythmia does not always need treatment. If it is disabling, then symptomatic treatment can be offered with caution that it is not very effective. However, trying benzodiazepines, antiepileptics, and even dopaminergic medications may be useful.
How do you manage orthostatic symptoms from autonomic neuropathy due to diabetes?
Try conservative measures such as hydration, pressure stockings, abdominal binder, exercises, and precautions prior to positional change. Addition of midodrine or other medications like flourinef and adjustment of doses of their antihypertensive medications. There are other medications that can be u...
What is a reasonable length of time to wait before performing a cardiac ablation for atrial fibrillation in a patient with an embolic stroke?
There is no data related to this question. If the deficits related to the stroke are mild to moderate, I would consider doing an ablation within a few weeks after an embolic stroke. With more severe deficits, I would wait longer.
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 would you approach the upfront management of a patient with acute unilateral vision loss with strong clinical risk factors for both cardioembolic stroke and GCA if an expedited MRI is not possible due to the presence of an AICD?
I'm definitely not an expert in this topic, but you have many clinical tools to increase/decrease your clinical suspicion for GCA vs. cardioembolic stroke. Some things I would ask: Is this patient currently in Afib? What's their CHADSVASC? Are they anticoagulated? Can we get a TTE to check for vege...
What is your approach to the evaluation of minipolymyoclonus?
The term minipolymyoclonus usually describes low-amplitude arrhythmic movements of the fingers seen when the arms are outstretched, which can be seen in several conditions. The evaluation would depend on the accompanying symptoms. For example, if minipolymyoclonus is seen in the setting of weakness ...
What is the role of inpatient psychiatric or psychological evaluation in patients who have had acute function change as an inpatient?
This is an important question. An acute change in function is a frequent reason for hospital admission and must be considered as a feature of some underlying medical, neurological, or psychiatric condition. It is important to know what functions have changed, including basic and instrumental activit...
What brain imaging findings do you find reliable to help support a diagnosis of idiopathic intracranial hypertension?
In a study by Bidot et al., PMID 26457687, transverse venous sinus stenosis (TVSS) was the most useful sign of IIH because of its high pooled sensitivity (97%) and specificity(93%). Orbital findings, such as optic nerve head protrusion, posterior scleral flattening, optic nerve tortuosity, and diste...
How do you approaach ischemic stroke from suspected symptomatic ipsilateral carotid web with less than 50% stenosis?
I would need to know what the definition of "suspected symptomatic" means in this setting. Is this the patient's first ischemic event? Or have there been multiple ischemic episodes? Is the stroke pattern sub-cortical/lacunar-type from uncontrolled microvascular risk factors or cortical-appearing sug...
How do you treat a mild basilar artery occlusion stroke?
I agree with the prior post and would like to add some additional insight from the interventional lens. As mentioned, NIHSS isn’t well-suited to posterior circulation strokes. From the intervention side, basilar occlusion can look deceptively mild on paper, but the outcomes are often anything but. I...