Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
Does receiving IVIG confound the result of SPEP and/or UPEP?
IVIG being a product of polyclonal immunoglobulins may ‘produce’ a monoclonal spike if the AUC is falsely calculated by the reader. IFE usually shows polyclonal banding but every now and then a monoclonal band is picked up. Being an IgG molecule with a 21 day halflife; and with the assumption that i...
When do you consider using general anesthesia for endovascular thrombectomy?
I perform all of my thrombectomy cases under general anesthesia. There is better hemodynamic control, no patient movement to manage, which increases procedural efficiency as a result. In moderate sedation cases, patients can feel aspiration and stent retriever passes through the vessel, which causes...
How do you taper dopamine agonists for RLS in patients experiencing augmentation?
Slowly. Abrupt withdrawal from agonists can cause mood dysregulation (dopamine agonist withdrawal syndrome) and in RLS patients, would likely exacerbate RLS symptoms.Adding gabapentin to the regimen prior to slow withdrawal of the agonist would probably help avoid worsening RLS symptoms during this ...
What is your strategy to help prevent paclitaxel-related neuropathy?
There are no proven strategies for prevention of CIPN and the use of these supplements is not recommended. Some supplements such as acetyl carnitine can actually worsen neuropathy outcomes and some supplements such as B12, vitamin C, and others may negatively interact with chemotherapy and worsen di...
Do you ever consider steroid treatment for grade 1 ICANS without CRS?
We typically do not, but these patients receive neurology consultation and are very closely monitored.
In patients presenting with disabling acute ischemic stroke symptoms early in the therapeutic window, would you consider anticoagulation reversal to enable administration of intravenous thrombolytics?
In short, 'no'. For patients who have a large vessel occlusion, there is the option of proceeding directly to EVT without thrombolysis. We know from the direct EVT trials that although concurrent or sequential thrombolytic drug treatment followed by EVT is better, it is better only by a small amount...
What is your approach for surveillance of coiled unruptured aneurysm?
DSA 6 months after initial coiling MRA TOFTR (time-of-flight time-resolved) thereafter
How do you decide on the next therapy for post-ICI triple M syndrome (myositis/myocarditis/myasthenia) after steroids, PLEX, and IVIG?
The short answer is that there is no standard of care, and no way to reliably predict which of the third-line treatments will work best for each individual. As an introduction, 3M syndrome is a horrible combination of 3 immune-related adverse events (iRAEs) after ICI exposure for cancer, including m...
When should you avoid initiating beta blockers in a patient with myasthenia gravis?
In general, my opinion is that there are very few medications that are absolutely contraindicated in MG, and those are: botulinum toxin, aminoglycosides, macrolide antibiotics, and possibly magnesium supplements (unless the patient has dangerous hypomagnesemia). Many other drugs, especially drugs us...
When do you consider sciatic nerve imaging in cases of foot drop without clinical or EMG involvement beyond the peroneal nerve without clearly indentified compression site?
I think it would be reasonable to image the sciatic nerve in this scenario. Many sciatic neuropathies, especially those caused by compression or inflammatory (vasculitic) lesions, tend to affect the peroneal division much more than the tibial, therefore clinically mimicking a peroneal neuropathy. Th...