Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Would you consider giving thrombolytic therapy for patients with acute vision loss concerning for CRAO based on history and within the window before any ophthalmological assessment and confirmation?
We have utilized a prior study to give tPA or tenecteplase within 4.5 hours of onset for CRAO. I would not do so, however, without an ophthalmology evaluation to confirm the likely diagnosis and to exclude an alternative diagnosis such as a retinal detachment.
When do you find ultrasound guidance to be most helpful for botulinum toxin injection?
I occasionally use ultrasound to survey the target muscle and neighboring structures such as blood vessels. I find this most helpful in the groin area or abdomen. The main difficulties with ultrasound relate to maintaining aseptic technique and needing an extra hand to control the probe in some situ...
How do you decide between Vyalev and Onapgo for patients who would benefit from continuous dopaminergic stimulation?
Either is fine.
Is there a role for bevacizimab (IV or IA) for steroid refractory radionecrosis for AVM?
Radiation necrosis (RN) following SRS can occur at variable intervals of time following treatment, usually occurring 9-18 months later. The preferred first line of approach is usually steroids, as done in this case. I usually look at the MRI-Flair images and determine the dose of dexamethasone depen...
Under what circumstances do you recommend POCUS guidance for lumbar puncture?
If the circumstances allow for it, I would use ultrasound for guidance for LP every time a LP is performed. This allows for continued practice in identification of the landmarks and improves accuracy in POCUS when it's truly needed, as in obese patients, where landmarks are difficult to palpate. Got...
Will you incorporate the use of tirzepatide in the management of patients with OSA?
Yes! However, the best methods to incorporate GLP-1s into the practice of Sleep Medicine have yet to be determined. Hopefully, our professional organizations can provide us with clinical practice guidelines to better direct our practice in this area.For those that have not had a chance to review, SU...
Do you utilize tumor treating fields in patients with anaplastic pleomorphic xanthoastrocytoma (PXA) III?
I would, but I haven't actually had the opportunity. With more information appearing that TTF is effective in brain metastases, mesothelioma, and pancreatic cancer, why wouldn't you use it if you didn't have a better option? The only real risk is financial.
How do you approach the medical evaluation of new onset psychosis in elderly patients?
The medical evaluation of new-onset psychosis begins with a thorough history (medical, neurologic, and psychiatric history), including a history of the present illness, medications, as well as the use of alcohol and recreational drugs. Obtaining information from family or others who know the patient...
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...
How do you determine the time window for which to monitor for cerebral edema development in patients with brain injury?
The type of edema definitely matters. The two big categories of cerebral edema include cytotoxic and vasogenic edema. Cytotoxic results from free water accumulation in dying cells from acute brain injury, while vasogenic edema results in disruption of the blood-brain barrier. The classic teaching is...