Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Do you consider immunosuppression in patients with a history of Sjogren's disease and clinical features of inclusion body myositis?
My short answer is no. The phenotype and MRI findings described in this case suggest IBM and recently published consensus criteria for the diagnosis of IBM require only the presence of endomysial lymphocytic inflammation in muscle biopsy as a mandatory criterion, along with supportive clinical pheno...
Are triptans contraindicated for migraine treatment in patients with sickle cell disease?
Although triptans are not formally contraindicated in sickle cell disease, many SCD patients have silent cerebral infarcts and significant cerebrovascular vasculopathy, which are absolute contraindications to triptans. A thorough assessment for silent strokes, such as MRI/MRA, is recommended, and ex...
What is your approach to discontinuing immunotherapy in stable MOGAD?
If stable on therapy x 1 year, I will discontinue without taper and follow closely.
Under what circumstances would you give nimodipine to patients with non-traumatic, non-anuerysmal subarchnoid hemorrhage?
In my practice, the decision to use nimodipine in non-traumatic, non-aneurysmal subarachnoid hemorrhage is largely guided by the hemorrhage pattern and perceived vasospasm risk. For classic perimesencephalic SAH with low blood burden and reassuring vascular imaging, I do not routinely continue nimod...
What is your antiplatelet strategy after aneurysm coiling?
In general, I don’t use antiplatelets for JUST coil embolization. A different scenario if we are planning or inadvertently need a stent.
How do you treat patients with stroke thought to be secondary to Lambl excrescence?
Pathophysiologically, these occur through sheer stress to the valvular endocardium causing small areas to be denuded followed by fibrin deposition and microthrombi formation on the endocardial injury, which can embolize. Histopathologically, they have similarities to fibroelastomas (which are larger...
Would you use a lumbar drain in a patient with spinal stroke from fibrocartilagenous embolism?
There are no clinical trials to suggest any benefit. Smaller studies - particularly case series have shown some benefit with the use of lumbar drain in the first 48 hours and keeping the pressure around 10 mmHg. These include mostly patients post a cardiovascular surgical procedure as a cause in the...
Is there a role for using an external ventricular drain (EVD) trial in the workup of normal pressure hydrocephalus?
Typically, the work-up of normal pressure hydrocephalus involves either a large volume lumbar puncture or a 48-72 hour lumbar drain trial (and sometimes both). An external ventricular drain would be too invasive.There is an excellent review article that was recently published regarding this topic:Ca...
What medications are preferred and contraindicated for insomnia in patients with a recent stroke or traumatic brain injury?
In acute brain injury (ABI), which includes stroke and traumatic brain injury the focus is often on neurorehabilitation. The presumption here is that the patient is medically and neurologically stable. For example, not having a stroke in evolution, uncontrolled gastrointestinal bleeding, or similar....
Is Migraine with Unilateral Motor Symptoms (MUMS) a diagnostic entity worth considering in patients with migraine and other associated symptoms?
I do not think so. It is not a part of the ICHD-3 criteria. If a patient with migraine disorder presents with weakness, it is possible that the weakness/motor symptoms are symptoms of migraine disorder. There is a diagnostic classification for such a patient already in the ICHD-3 criteria, which wou...