Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
How do you approach tapering high dose continuous infusions for status epilepticus in patients experiencing serious medication-related toxicity?
The short answer is as quickly as possible. How you do it will somewhat depend on the need for ongoing continuous infusion of a sedative for treatment of status epilepticus. Probably the most severe toxicity syndrome is Propofol-Related Infusion Syndrome (PRIS), which if not recognized early, can le...
When is the earliest you escalate treatment for prolonged migraine attacks to parenteral or emergency-level care?
After about 36 hours of status migrainosus.
When do you check thoracic paraspinals on needle EMG in suspected myopathy or myositis?
The need to sample the paraspinal muscles (especially thoracic) in suspected myopathy is diminishing with more sophisticated genetic testing and better antibody testing for inflammatory myopathies. The most common disorder that people learn to remember to sample the paraspinal muscles in Pompe disea...
What objective tools do you use to help determine if a patient is too high risk for anticoagulation to prevent stroke or DVT?
There are a number of risk scores, like HAS-BLED, that can be used, but I continue to use clinical judgment and shared decision-making. The excellent risk profile of NOACs and the availability of LAAO mean that I can usually come up with a solution for almost every patient that will protect them fro...
What do you do as part of a baseline neurologic exam pre-CAR-T therapy in addition to the ICE score?
I treat pediatric patients, and we do a baseline routine neurological exam before CAR-T, nothing else specific.
Under what circumstances do you recommend POCUS guidance for lumbar puncture?
I agree with Dr. @Dr. First Last. As with many other skills in medicine, repetition is key to mastering POCUS skills. So, if available, I always use ultrasound to assist with lumbar punctures. You are improving your skills and increasing your success rate at the first needle pass, improving patient ...
How do you counsel non-diabetic patients who wish to start metformin to reduce the risk of developing dementia?
There have been some interesting observational studies evaluating the reduction of cognitive decline in patients with type 2 DM. First, they are all in patients WITH diabetes, so not yet generalizable to patients without DM. Second, they are observational trials, which means that they cannot adjust ...
When would you obtain optic nerve testing in patients suspected to have multiple sclerosis without a clinical history of optic neuritis?
A key change in the 2024 revision of the McDonald criteria is the addition of the optic nerve as a fifth anatomic location to demonstrate dissemination in space (DIS) in addition to periventricular, cortical/juxtacortical, infratentorial, and spinal cord, which were included in the 2017 criteria. Op...
When do you find FDG-PET/CT helpful in the workup for autoimmune encephalitis?
Never. I only use MRI.
How do you approach managing nausea and GI side effects when initiating methotrexate?
There are several strategies to minimize nausea and gastrointestinal symptoms with the use of methotrexate. The medication can be taken with food, just not with caffeine. The dose can be split throughout the day it is taken such as half the dose in the morning and the other half in the evening. The ...