Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you counsel elderly patients who demonstrate mild cognitive impairment but do not meet the criteria for a neurocognitive disorder?
I would let them know that mild cognitive impairment (MCI) is an umbrella diagnosis with many different contributing factors as well as risk factors for progression to dementia. Control what you can control. Limit contributing factors such as pain, mood, and sleep optimization, as well as limiting a...
When do you consider ambulatory EEG to assess for future seizure risk in someone with seemingly resolved acute symptomatic seizures?
Generally, when I am unsure if the known events are truly symptomatic or whether they may represent more of a risk of recurrence without the "acute" etiology.
How would you manage leptomeningeal disease of the spine in the setting of prior WBRT?
This is an extremely challenging clinical situation. The decision points depend on treatment goals: If the goal is local palliation, simply treat local areas of disease, e.g. spinal segments. If effective systemic therapeutic options are available, obviously consider those first, including intrathe...
How do you manage Moya-Moya disease medically for patients that are unable to receive EC-IC bypass?
It depends on the cause. Usually for patients either moya moya disease (in contrast to moya moya syndrome where symptomatic patients would benefit from EDAS or surgical management ) due to atherosclerosis or radiation induced if someone has continued ischemic events or silent infarcts on aspirin mon...
Do you recommend life long aspirin 81 mg daily for non-specific T2 white matter hyper-intensities on MRI brain?
"Non-specific" means non-specific, indeed, and ASA risks of bleeding increase with age.
What behavioral interventions have you found most effective for managing self-injurious behavior in autism?
I think you'll find some good information in this related post: https://www.themednet.org/question/21993
How do you treat restless leg syndrome in patients with end-stage renal disease?
Based on the 2025 guidelines for RLS in patients with ESRD, I would recommend first checking iron studies and using IV iron sucrose if ferritin and transferrin saturation meet the criteria since the use of iron in this population has moderate certainty of evidence. If an iron infusion is not helpful...
How can you differentiate vessel wall enhancement related to CNS vasculitis versus atherosclerotic changes on MRA brain vessel wall imaging?
On MRA brain vessel wall imaging (vWI), central nervous system (CNS) vasculitis typically presents with concentric, uniform vessel wall enhancement and thickening, reflecting a diffuse inflammatory process involving the entire circumference of the vessel wall. In contrast, atherosclerotic changes mo...
What is your approach to addressing dementia-related agitation for patients living at home with family?
There is absolutely no simple way to answer that question. Even when the family is providing a very calm and nonconfrontational environment, avoiding any possible way of causing the agitation, it is virtually impossible to predict when and why a person with dementia would become agitated, angry, unp...
What would prompt you to consider a sleep study for narcolepsy in a child or adolescent with new-onset hallucinations?
It would depend on other elements of the history. The age of the child, the timing of the hallucinations, particularly if they are associated with sleep, onset or awakening, other hypersomnia disorder symptoms, and the child's psychiatric history. Generally, I have a very low threshold for an in-lab...