Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
When do patients with descending paralysis and suspected botulism require inpatient EMG?
If a health care provider suspects botulism in a patient presenting with descending paralysis (beginning from the cranial/bulbar region) and certain clues such as autonomic nerve involvement with dilated poorly reactive pupils, constipation, etc. can help, then treatment must be administered immedia...
When should we order a DaT scan in patients suspected of Parkinsonism syndrome?
I believe that a good clinical examination can tell you if a patient has parkinsonism or not and that is the same answer one gets from a DaTscan. If the findings are too subtle, then re-examine the patient at intervals. So my answer is it is not necessary. I emphasize "my" answer because not everyon...
What are your recommendations for screening for sleep disorders in patients with IDD?
Sleep disorders are very common for people with IDD. One consideration, in particular, is in patients with Down Syndrome because of the shape of their mouth and large tongue. They have a very high rate of sleep apnea, obstructive sleep apnea in particular, which can be seen even in children. You wo...
Does global brain atrophy increase risk for intracranial bleed after fall in older adults?
It depends on the location of the hemorrhage. Subdural bleeding/hematoma is much more likely in elderly people with brain atrophy and a fall. Epidural hemorrhage is much more common in young patients. Intracerebral hemorrhage is more related to risk factors such as hypertension in middle age and amy...
What MRI findings would you consider compatible with an acute seizure or seizures?
Frequent seizures and status epilepticus can result in reversible neuroimaging findings such as cortical enhancement, DWI cortical ribboning, and decreased attenuation on CT. Imaging findings can be resolved with control of seizures.Hormigo et al., PMID 15023812Kramer et al., PMID 3653056Riela et al...
How do you determine if generic vs. brand formulation of a DMT is the probable cause of worsening multiple sclerosis disease activity?
I based this on the timing of the switch to generic formulations and the duration of stability on brand formulation. For example, if a patient has been on brand DMT with stability for 5 years, then recently changed to generic with disease activity within the first year, I would consider that the gen...
Would you recommend muscle or nerve biopsy in a patient with amyoplasia congenita?
No, I would not for at least 2 reasons. The probability of getting a quality sample is very low, and it is most likely that no muscle would be obtained as the name of the disorder implies (amyoplasia). Furthermore, the likelihood of finding a genetic cause for this is VERY low. In fact, in using WES...
What is your approach to Tardive Dyskinesia when VMAT2 inhibitors are ineffective or unaffordable?
In established cases of tardive dyskinesia, in which withdrawal-emergent dyskinesia has been ruled out, and dyskinesia has persisted despite a sufficient washout interval after removal of the offending agent, VAM2 inhibitors such as valbenazine and deutetrabenazine are used for pharmacotherapy. If t...
How will your approach to screening and diagnosis of early dementia change given newly available therapies for early Alzheimer's disease?
As it stands, it is not recommended to screen asymptomatic patients for the proteins seen in Alzheimer’s disease outside of clinical trials (i.e., AHEAD 3-45). However, with the emergence of new treatment options in the clinic, I foresee an influx of patients with cognitive symptoms who need a preci...
How do you approach a patient with both a resting and action tremor, suggestive of PD and essential tremor together?
This is a wonderful question. To answer this question, we first have to look at the underlying etiology that leads to action tremor in PD. The hallmark of Parkinson's Disease (PD) is rest tremor, and about 75% of patients with PD have rest tremor at some point in their disease course (typically more...