Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How long would you continue chronic transfusion therapy for adult sickle cell patients who have had a stroke?
There is no high-level evidence to inform the decision of how long to continue chronic transfusion in this scenario. Decisions on whether to continue indefinitely are affected by multiple factors like the presence of RBC alloimmunization, whether the patient was on hydroxyurea at MTD or not at the t...
How do you manage autonomic symptoms in patients with myasthenia gravis?
Autonomic symptoms are not common with myasthenia gravis. If you encounter autonomic symptoms, try to assess for etiology, and management would be similar to other autonomic conditions.
Which non-pharmacologic treatments for neuropathic pain have you found most effective?
I am dual-boarded in neurology and pain medicine. This question is non-specific, and therefore, none of the above is correct. Neuropathic pain is not a specific diagnosis and therefore it does not have a specific treatment option. The answer is to please see a board-certified interventional pain phy...
Is the p-tau217 plasma test used as a surrogate for amyloid PET scan or CSF testing when considering starting Leqembi in patients with Alzheimer's disease?
P-tau127 is an excellent surrogate for amyloid, though it is not yet standard practice. Currently, there are no best practice guidelines on whether p-tau217 alone is sufficient or if it needs to be combined with Aβ42/Aβ40 or APOE4. These are available clinically but not yet FDA-approved. The FDA-app...
When do you consider thrombectomy for patients with LVO and carotid dissection?
In most situations, unless there is no deficit, NCCT shows ICH, or CTP shows no significant penumbra. Dissection in itself is not a contraindication to thrombectomy.
How well does a negative non-contrast MRI of the brain exclude metastasis in a patient with squamous cell carcinoma of the lung?
I don't think the question has enough information to give a good answer. For example, if it was a T3, N2 NSCLC, or a small cell, then "yes" I'd repeat the MRI with contrast. On the other hand, if it was a T1, N0 NSCLC, then "no", I wouldn't. In other words, if I thought there was a real risk of havi...
Do you recommend work up for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
Would a longstanding diagnosis of multiple sclerosis impact your radiation recommendations for a patient with breast cancer?
In my opinion, the simple answer is no. At least not in my experience treating one MS patient with whole breast radiation. Unlike Scleroderma, which is an autoimmune disease that can result in inflammation and thickening of the skin, connective tissues, and internal organs, MS is an autoimmune disea...
Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?
Lupus anticoagulants are a heterogeneous group of antibodies that do not have uniform activity in all assays. Furthermore, testing procedures are not well-standardized. Since relevant clotting factor deficiencies have been ruled out and the long PTT does not correct with mixing, and since there is o...
When should surgical tumor resection be considered in patients with a low-grade glioma?
In adults with low-grade gliomas, there is substantial evidence suggesting that aggressive, early surgical resection improves outcomes and survival (Jakola et al., PMID 23099483). Historically, this has been particularly true for tumors that carry an IDH mutation or 1p/19q codeletion. This survival ...