Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Is there sufficient evidence yet to support the use of lithium supplementation or prescription in the management of neurodegenerative diseases?
No.I assume the question was written in response to a recent publication in Nature (Aron et al., PMID 40770094), highlighting recent research in mouse models where lithium deficiency in the brain led to accelerated amyloid pathology, which could be in part reversed by replacement.I want to remind th...
How do you decide when to pursue malignancy workup for patients with cryptogenic stroke?
Agree with above. I would also pursue malignancy work-up in this scenario as well: currently on anticoagulation (whether for afib or another medical reason) and has an ischemic stroke on top of that.
When do you suspect an autoimmune encephalitis in a child or adolescent with new-onset psychosis?
Given the rarity of true childhood schizophrenia, autoimmune encephalitis, and other medical etiologies should be considered in any patient presenting with new-onset psychosis prior to age 13. In adolescents, sudden onset of symptoms, absence of family history, lack of prodrome, and other atypical p...
For a patient with glioblastoma also found to have a distant presumed meningioma with a location/size such that you would have otherwise recommended RT, would you offer concurrent treatment?
I think if the situation is non-urgent and the lesion (meningioma) can be safely monitored, one approach would be to prioritize treatment of the glioblastoma while observing the meningioma. If, however, the meningioma demonstrates interval growth and/or is located in an area at higher risk for causi...
When do you opt for MRI brain in addition to CTA/CTP for evaluating eligibility for extended window thrombolysis?
In a patient with disabling deficits (regardless of location), if the last known well time is unknown, but the symptom discovery was within 4.5 hours, we pursue an MRI to assess for IV thrombolysis eligibility after obtaining the initial CT head and CTA, and if there is no intervenable (per standard...
Cost and access aside, when might you prefer to start a patient on a triptan instead of a gepant for acute migraine therapy?
For me, the triptans are first line for migraine abortion. They have been on the market for well over three decades, we have a lot of experience with them, a lot of clinical-trial information is available on them, and also in special populations like teenagers and adolescents, as well as pregnant wo...
How do you counsel patients on how to take abortive migraine medications during the prodrome period?
I do not routinely counsel patients to take abortive treatments during prodrome. It would depend on headache frequency. It would be hard if their headache frequency is high, such as >8-10 headache days per month, as they may run out of their abortive treatment. If they have low headache frequency an...
How does osteoporosis or fracture risk affect your use of CGRP monoclonal antibodies?
As far as I know, this is a purely theoretical concern. Time will tell, and, in addition, we have very effective treatments available for osteoporosis, if this is an issue.
What treatment strategies can reduce the risk of post-concussion syndrome after an acute injury?
When evaluating a patient for their acute concussion, it is important to screen in the history for known factors that can prolong recovery if unaddressed. These include: sleep, hydration, mood issues, lack of activity for more than 48 hours, history of migraines, ADHD, anxiety, and depression. In th...
What is the role for inpatient limited-montage EEG recording?
Unequivocal YES! For purposes of detecting severe seizures that cause brain injury (i.e., high seizure burden, status epilepticus), a reduced montage EEG is more than adequate, performs equivalently, and in fact BETTER because of the Clarity AI algorithm which continuously monitors, interprets, and ...