Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do you, if ever, use plasma exchange for multiple sclerosis flares?
I have considered PLEX for patients who have new relapses or enhancing lesions within 30 days of high-dose steroids. Unfortunately, it has been difficult to get this approved by the hospitals, and I have had to either use an additional course of high-dose steroids or IVIG. For those who do not have ...
In an older adult hospitalized with recurrent falls, weight loss, without clear injuries, but with an inconsistent or difficult-to-reach caregiver, what findings would make you formally report suspected elder neglect and/or abuse?
I'm so glad that you're thinking about the possibility of abuse/neglect in this scenario! It's important to have it on our differential, or we'll always miss this diagnosis. First, it would be good to see if the patient can explain what is happening and provide contextual information that veers us a...
Which patients with oligodendrogliomas are good candidates for vorasidenib to delay radiation therapy?
Patients with WHO 2 tumors without enhancement who have had gross total resections and have no worrisome molecular pathology findings usually do better with upfront vorasidenib, delaying more aggressive interventions with chemotherapy and radiation, often for years, sometimes decades, and occasional...
Do you typically load DAPT in patients with ICAD?
If the ICAD lesion is symptomatic and the patient is aspirin-naive, I administer a one-time loading dose of 325 mg of aspirin, followed by 81 mg after that. I do not administer a loading dose of the P2Y12-inhibiting agent (such as clopidogrel, ticagrelor, etc.). I continue DAPT for 3 months then tra...
What recommendations do you have for patients with post-vaccination neurologic amyotrophy (Parsonage-Turner syndrome) regarding their future vaccinations?
Neuralgic amyotrophy (NA), acute brachial neuritis (ABN), or PTS are, inter alia, several names for an inflammatory microvasculitic plexopathy. Its broad presentation can range from a highly restricted “fasciculopathy” to a pan-plexopathy. The decision of whether to vaccinate after post-vaccinationa...
Do you counsel patients to acutely treat migraine with aura at the onset of aura or headache?
The timing of acute treatments for migraine attacks has been widely discussed for a number of years. Here are some principles: Once the pain begins, pain-free rates are higher if the patient treats early in the attack, while the pain is still mild. This is broadly true for triptans, NSAIDs, aspirin...
Does screening for sleep apnea in asymptomatic patients reduce long-term dementia risk?
Obstructive sleep apnea (OSA) is common, underdiagnosed, and increasingly recognized as a potentially modifiable contributor to late-life cognitive decline. Observational studies consistently report associations between OSA, intermittent hypoxemia, sleep fragmentation, cerebrovascular injury, Alzhei...
How long can demyelinating findings persist on nerve conduction studies (NCS) after AIDP illness?
This question was studied in a retrospective review in Muscle and Nerve (Guémy et al., PMID 36814082) in a group of patients with AIDP. At least one feature of demyelination was present in 23% of the cohort (14 out of 61) up to 2 years after the onset of the AIDP-like illness. Using the EFNS-PNS cri...
How do you counsel post-menopausal women interested in hormone replacement therapy as a treatment for multiple sclerosis?
Postmenopausal HRT is not established as relapse-prevention, neuroprotection, or progression therapy in MS. I do not recommend HRT to treat MS. I support HRT for bothersome menopausal symptoms when there are no contraindications, as treating sleep disruption, hot flashes, mood symptoms, urogenital s...
Do you routinely obtain a biopsy of a presumed meningioma prior to SRS to confirm grade 1?
There is an emerging and growing body of data using various AI tools and radiomics analysis, as well as the incorporation of advanced imaging, that aim to improve the ability to predict the grade of meningioma. Most of this work remains "limited institution" in terms of applicability. In the current...