Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Which factors help you choose between intermittent phenobarbital dosing versus continuous pentobarbital infusion for pharmacological burst suppression in refractory status epilepticus?
I am not aware of any guidelines or data that recommend the use of phenobarbital over pentobarbital for burst suppression in refractory status epilepticus. In fact, guidelines tend to favor pentobarbital in patients who have failed propofol and midazolam. Phenobarbital can certainly be used for seiz...
How do you identify patients with false positive AcHR antibodies?
First of all, of course, one should look for the clinical correlation. Even a weakly positive AchR binding antibody is likely to be "real" (true positive) if accompanied by unequivocal clinical signs of MG, e.g., fatigable ptosis with positive ice pack test, or fatigable bulbar/limb weakness. Ideall...
To what extent do you incorporate electrodiagnostic testing and ultrasonography in your clinical practice for evaluating suspected cases of meralgia paresthetica?
In my opinion, meralgia paresthetica is one of the easiest diagnoses of focal entrapment neuropathy that a neurologist (or even GP) can make based on clinical exam alone. I don't know any other disorder that presents with isolated sensory symptoms and signs of sensory loss limited to the lateral thi...
Do you start an anti-seizure medication in a patient with a first unprovoked nocturnal seizure with a normal exam, imaging, and EEG; or wait until the second seizure?
Not with the first seizure unless history suggests otherwise. Also, what is the age of the patient? For example, are benign epilepsy syndromes like rolandic epilepsy on your differential? If age does not fit, monitor the patient clinically. Repeat EEG after a few months with sleep recorded.
How do you approach pain management in patients with idiopathic polyneuropathy?
There are a few different guidelines/recommendations depending on which professional society you search. However, I tend to adhere most closely to the table cited below, with an approach that looks something like: First line: Gabapentin 300mg TID titrating up to 1000mg TID Pregabalin 75mg BID titra...
Are there instances where tracheostomy alone without mechanical ventilation can be sufficient to manage neuromuscular respiratory failure?
This is a very rare circumstance in our assisted ventilation clinic. This situation usually arises because a patient underwent tracheostomy during an acute illness while they were requiring invasive ventilatory support, and were able to wean from the ventilator but had dyspnea or hypercarbia while t...
Do you always initiate hypercoagulable work up in a patient with recurrent stroke?
As always, this is a more complex problem than it appears. A history of both prior other thrombosis and family history of thrombosis is essential. Are there good reasons for the stroke and/or has it been worked out in past including carotid disease, atrial fibrillation, underlying malignancy, valvul...
How will you treat a young man with recurrent cryptogenic strokes with no identifiable cause, with MTHFR A1298C homozygous mutation and normal homocysteine level?
The genetic variant you report seems to be a SNP that, while it has been reported to be statistically associated with various diseases in GWAS studies, is not pathogenic. SNPs that are significant in GWAS studies have very small effect sizes that can be measured when considered in thousands of peopl...
What is your preferred imaging modality for determining infarct core when evaluating acute stroke cases?
I agree with prior responses. In most cases, a combination of CT & CTA with ASPECTS scoring & collateral assessment is sufficient to determine infarct core burden. I don't routinely rely on MRI for EVT or thrombolysis assessment due to logistical and/or time constraints. CTP can be hit or miss, but ...
How do you decide between the gene silencing drugs for familial amyloidosis with polyneuropathy?
The data to answer this question are very limited to non-existent, exactly because there have been no studies with a head-to-head comparison of the efficacy of different agents. Ultimately, it's a shared decision between the patient and the physician, which should take into account factors such as p...