Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How does the presence of 1-3 microbleeds on MRI influence your choice of anti-amyloid therapies for patients with MCI or mild AD?
1-3 microbleeds is a small number, and the question does not specify that to be suspicious for amyloid angiopathy, the microbleeds should be cortical/subcortical, not deep (as seen in hypertensive individuals). This number, assuming that there are no signs of a larger hemorrhage nor superficial side...
How do you approach evaluation of a patient referred for mononeuritis multiplex and +SSB?
I would look at the history/timeline of the illness and any other lab studies suggesting inflammation and/or immune activation, along with any family history of autoimmunity (or cancer).Mononeuritis multiplex is primarily a result of small vessel vasculitis resulting in ischemia to nerves and often ...
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....
Do you view the difference between oral and sublingual cyclobenzaprine as clinically significant?
Yes. Oral cyclobenzaprine—a TCA analogue structurally identical to amitriptyline aside from a single double bond—has been used off-label for fibromyalgia for many years. Despite long-standing anecdotal benefit, a prospective placebo-controlled RCT showed only transient improvement at 4 weeks, with n...
How do you determine the timeline for healing after craniotomy prior to starting chemotherapy and radiation?
I typically wait at least 10-14 days post-op, always after neurosurgery has re-evaluated the craniotomy site for appropriate healing and has already removed staples or sutures.
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...
What tools do you use to evaluate for cognitive deficits in young patients?
I typically screen patients for the usual suspects when the working memory is the complaint. These include poor sleep quality, pain anywhere in the body, stress, anxiety/depression. These factors distract the brain and make it difficult to focus and perform cognitively. By addressing these factors, ...
Have you changed your practice in treating CRAO with IV thrombolysis?
The recent THEIA trial had a limited sample size to draw conclusions, even though there was a non-significant trend of improved visual acuity initially in the thrombolysis group. Even the TenCRAOS trial had a small sample size with recruitment challenges, where subtle small differences cannot be acc...
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...