Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What are your top takeaways in Neuro Oncology from ASCO 2026?
The study on TMZ use duration. And the CAR T talk.
Would you consider empiric anticoagulation in patients with an acute stroke for whom you have high suspicion for cardioembolic source, but have not yet confirmed LV thrombus, atrial fibrillation, etc.?
In practice, I would rarely consider empiric anticoagulation after an acute ischemic stroke without a confirmed cardioembolic source. I would not consider this approach for suspected LV thrombus, as transthoracic echocardiography is routinely available in the inpatient setting and can quickly confir...
What serum biomarkers are most helpful in cardiac arrest prognostication?
Neuron-specific enolase. This is checked at 24, 48, and 72 hours. It is, however, NOT to be used in isolation for prognostication, which is multimodal, including clinical exam after clearance of sedation (typically at 5 days post arrest), EEG (e.g., looking for reactivity of background), NSE, and MR...
What imaging do you recommend for patients with suspected CSF leak?
MR brain is usually the best place to start, but if you have a high clinical suspicion and unrevealing results, there are a few other imaging methods to consider. CT myelogram is the gold standard for spinal leaks, and a combination of high-resolution CT and CT cisternography can be useful for crani...
What treatment strategies would you utilize in a patient with newly diagnosed HLA-B27+ axial spondyloarthritis (with active and chronic sacroiliitis on MRI) and recent diagnosis of MS that is well-controlled MS ocrelizumab given the need to avoid TNF inhibitors?
This is a very challenging scenario. On one hand, TNFi are generally unsafe for MS due to demyelination risk, and on the other hand, anti-CD20 therapies for MS are linked to new AxSpA, but B-cell depletion might also benefit AxSpA. Thus, management requires specialized care in balancing both disease...
What is your approach towards continuing cancer screening in a young adult with Tif-1+ dermatomyositis, and negative initial CT chest/abd/pelvis?
Young TIF-1 is likely behave as juvenile DM with TIF-1, where the risk of cancer is much lower. I have many young TIF-1 that never developed cancer. I still think that careful ongoing monitoring is needed for 3 years from diagnosis. For cancer risk assessment and management, use the International gu...
For patients with hydrocephalus secondary to leptomeningeal disease, how do you determine what type of shunt device to place?
For my small part, please ask neuro-oncology if they plan to use intrathecal chemo (and need a hybrid with Ommaya).
How do you approach an acute non-LVO stroke with a known large core (>70 mL, 0-5 ASPECTS, or other metric)?
As with any treatment, you have to weigh the individual patient characteristics and overall risks vs. benefits. If there is no LVO, then the question is whether to pursue thrombolysis. In the extended window, thrombolysis was really only helpful in very small core patients, so if the patient is beyo...
When do you consider EVD in pediatric severe TBI when initial imaging is unremarkable?
The guidelines state that intracranial pressure monitoring is indicated for severe TBI when GCS is 12 or less, regardless of what the head imaging looks like. Either a bolt or an EVD can be used for measuring intracranial pressure. In cases where our index of suspicion for elevated intracranial pres...
How do you treat behavioral changes in patients with temporal lobe epilepsy?
People with epilepsy (PWE) are much more likely to suffer from comorbid psychiatric problems during their lifetime, with about 1 in 3 PWE experiencing psychiatric symptoms at some point. In general, patients with psychiatric symptoms and coexisting epilepsy should be managed much the same as anyone ...